Individual
MITCHELL FAMBROUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
632 FOGG ST, NASHVILLE, TN 37203-4656
(615) 418-7461
Mailing address
632 FOGG ST, NASHVILLE, TN 37203-4656
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
219568
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NOT ISSUED
TN
Enumeration date
08/10/2019
Last updated
08/10/2019
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