Provider Demographics
NPI:1487832614
Name:ANTIOCH MEDICAL ASSOCIATES P C
Entity type:Organization
Organization Name:ANTIOCH MEDICAL ASSOCIATES P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERTRUDE
Authorized Official - Middle Name:O
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:615-781-0200
Mailing Address - Street 1:393 WALLACE RD
Mailing Address - Street 2:SUITE A302
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4880
Mailing Address - Country:US
Mailing Address - Phone:615-781-0200
Mailing Address - Fax:615-331-0366
Practice Address - Street 1:393 WALLACE RD
Practice Address - Street 2:SUITE A302
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4880
Practice Address - Country:US
Practice Address - Phone:615-781-0200
Practice Address - Fax:615-331-0366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20566207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3716111Medicare PIN