Provider Demographics
NPI:1871586545
Name:CONWAY, EDMOND TANNER (FNP C)
Entity type:Individual
Prefix:MR
First Name:EDMOND
Middle Name:TANNER
Last Name:CONWAY
Suffix:
Gender:M
Credentials:FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 WALLACE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4893
Mailing Address - Country:US
Mailing Address - Phone:615-832-5530
Mailing Address - Fax:615-832-5713
Practice Address - Street 1:330 WALLACE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4893
Practice Address - Country:US
Practice Address - Phone:615-832-5530
Practice Address - Fax:615-832-5713
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN110453207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S48438Medicare UPIN
3048316Medicare PIN
S48438Medicare UPIN