# PONTCHARTRAIN MEDICAL GROUP, A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356704357
- **Authorized official:** MARK A CALARCO DO (CEO)
- **Authorized official phone:** (615) 712-5862

## Contact information

- **Practice address:** 200 POWELL PL, ATTN: LEGAL DEPARTMENT, BRENTWOOD, TN 37027-7514
- **Practice address phone:** (615) 732-1605
- **Mailing address:** 200 POWELL PL, ATTN: LEGAL DEPARTMENT, BRENTWOOD, TN 37027-7514
- **Mailing address phone:** (615) 732-1605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | — | — | — |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | NULL | Yes |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/29/2016
- **Last updated:** 08/25/2021