Provider Demographics
NPI:1982777140
Name:PEDIATRIC ASSOCIATES OF DAVIDSON COUNTY, P.C.
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF DAVIDSON COUNTY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-329-3595
Mailing Address - Street 1:2201 MURPHY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1835
Mailing Address - Country:US
Mailing Address - Phone:615-329-3595
Mailing Address - Fax:615-327-4934
Practice Address - Street 1:2201 MURPHY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-329-3595
Practice Address - Fax:615-327-4934
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC ASSOCIATES OF DAVIDSON COUNTY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-16
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3704727Medicaid