Provider Demographics
NPI:1295761476
Name:NAVBRHLTHCL
Entity type:Organization
Organization Name:NAVBRHLTHCL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER IN CHARGE
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:W
Authorized Official - Last Name:GERHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-874-6100
Mailing Address - Street 1:5722 INTEGRITY DR
Mailing Address - Street 2:BLDG S-771 NAVSUPACT MID SOUTH
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38054-5028
Mailing Address - Country:US
Mailing Address - Phone:901-874-5471
Mailing Address - Fax:
Practice Address - Street 1:5722 INTEGRITY DR
Practice Address - Street 2:BLDG S-771 NAVSUPACT MID SOUTH
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38054-5028
Practice Address - Country:US
Practice Address - Phone:901-874-5471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 2106261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center