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Organization
NORTHSIDE MEDICAL PROFESSIONALS, P.C.
Active
Organization
NORTHSIDE MEDICAL PROFESSIONALS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHAWN GENTRY M.D. (COO)
(931) 540-4210
Entity
Organization
Contact information
Practice address
1605 NASHVILLE HWY, STE. 200, COLUMBIA, TN 38401-2071
(931) 540-4210
(931) 380-1202
Mailing address
1605 NASHVILLE HWY, STE. 200, COLUMBIA, TN 38401-2071
(931) 540-4210
(931) 380-1202
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
09/28/2010
Last updated
09/28/2010
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