| Middle Tennessee Psychiatry Group Incorporated | |
|
225 N Willow Ave Ste. 1 Cookeville TN 38501-2335 | |
| (931) 372-8700 | |
| (931) 372-8717 |
| Full Name | Middle Tennessee Psychiatry Group Incorporated |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 225 N Willow Ave, Cookeville, Tennessee |
| Authorized Official Name and Position | Viswa Bharathi Durvasula (M.D.) |
| Authorized Official Contact | 9313728700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Middle Tennessee Psychiatry Group Incorporated 225 N Willow Ave Ste. 1 Cookeville TN 38501-2335 Ph: (931) 372-8700 | Middle Tennessee Psychiatry Group Incorporated 225 N Willow Ave Ste. 1 Cookeville TN 38501-2335 Ph: (931) 372-8700 |
| NPI Number | 1265709208 |
|---|---|
| Provider Enumeration Date | 11/18/2011 |
| Last Update Date | 04/24/2013 |
| Medicare PECOS PAC ID | 9931347523 |
|---|---|
| Medicare Enrollment ID | O20130520000714 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265709208 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD20037 (Tennessee) | Primary |
| Provider Name | Viswa Bharathi Durvasula |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1447392527 PECOS PAC ID: 6901893684 Enrollment ID: I20040426001563 |
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