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Organization
CLEANSLATE MEDICAL GROUP OF KENTUCKY PLLC
Active
Organization
CLEANSLATE MEDICAL GROUP OF KENTUCKY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL ROGERS ANDERSON (VICE PRESIDENT)
(615) 425-0220
Entity
Organization
Contact information
Practice address
6801 DIXIE HWY STE 132, LOUISVILLE, KY 40258-3952
(502) 657-2701
(833) 279-7074
Mailing address
155 FRANKLIN RD STE 430, BRENTWOOD, TN 37027-1602
(154) 250-0220
(833) 279-7074
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
NULL
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
03/09/2017
Last updated
08/26/2026
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