Provider Demographics
NPI:1871770123
Name:CHOTHMOUNETHINH, PHAYTHOUNE (MD)
Entity type:Individual
Prefix:DR
First Name:PHAYTHOUNE
Middle Name:
Last Name:CHOTHMOUNETHINH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:629-888-5175
Mailing Address - Fax:629-888-5176
Practice Address - Street 1:114 SAUNDERSVILLE RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-8967
Practice Address - Country:US
Practice Address - Phone:629-888-5175
Practice Address - Fax:629-888-5176
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ80815207Q00000X
TN46218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1520506Medicaid