Organization
MID STATE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NORIDIA MAURAS D.O. (OWNER)
(615) 390-0708
Entity
Organization
Contact information
Practice address
1525 HUNT CLUB BLVD, SUITE 600, GALLATIN, TN 37066-6070
(615) 230-9095
Mailing address
PO BOX 309, GALLATIN, TN 37066-0309
(615) 230-9095
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
1782
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093725533
NPI
—
05
—
3736067
—
TN
Enumeration date
08/08/2006
Last updated
02/14/2008
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