Provider Demographics
NPI:1932786290
Name:PBH PROFESSIONAL GROUP, P.A.
Entity Type:Organization
Organization Name:PBH PROFESSIONAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SADRI-AZARBAYEJANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:615-308-7871
Mailing Address - Street 1:103 POWELL CT STE 100
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5050
Mailing Address - Country:US
Mailing Address - Phone:615-308-7871
Mailing Address - Fax:615-261-8901
Practice Address - Street 1:2219 W EULESS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-6624
Practice Address - Country:US
Practice Address - Phone:817-857-9110
Practice Address - Fax:817-391-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty