Provider Demographics
NPI:1235320326
Name:NASHVILLE DERMATOLOGY & SKIN CANCER CLINIC
Entity type:Organization
Organization Name:NASHVILLE DERMATOLOGY & SKIN CANCER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:TILLMAN
Authorized Official - Last Name:KEYES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-327-2075
Mailing Address - Street 1:222 STATE ST.
Mailing Address - Street 2:SUITE A
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1869
Mailing Address - Country:US
Mailing Address - Phone:615-327-2075
Mailing Address - Fax:615-329-4058
Practice Address - Street 1:222 STATE ST.
Practice Address - Street 2:SUITE A
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1869
Practice Address - Country:US
Practice Address - Phone:615-327-2075
Practice Address - Fax:615-329-4058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD28596174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3044049OtherBCBS
TN5066203OtherAETNA
TN3387184Medicare PIN