| Old Hickory Psychiatric Assn Pllc | |
|
706 Cadet Ct Lebanon TN 37087-2649 | |
| (615) 206-9111 | |
| (615) 789-8315 |
| Full Name | Old Hickory Psychiatric Assn Pllc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 706 Cadet Ct, Lebanon, Tennessee |
| Authorized Official Name and Position | Don J Elazar (CHIEF MANAGER) |
| Authorized Official Contact | 6152069111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Old Hickory Psychiatric Assn Pllc 695 Nashville Pike 313 Gallatin TN 37066 Ph: (615) 206-9111 | Old Hickory Psychiatric Assn Pllc 706 Cadet Ct Lebanon TN 37087-2649 Ph: (615) 206-9111 |
| NPI Number | 1376634907 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 12/01/2022 |
| Certification Date | 12/01/2022 |
| Medicare PECOS PAC ID | 5890710271 |
|---|---|
| Medicare Enrollment ID | O20051014000268 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376634907 | NPI | - | NPPES |
| 3879766 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 35261 (Tennessee) | Primary |
| Provider Name | Don J Elazar |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1730370610 PECOS PAC ID: 3173586625 Enrollment ID: I20041117001058 |
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