Organization
CLARKSVILLE SPORTSMED & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SYED AHMED NASEERUDDIN MD (MEDICAL DIRECTOR)
(931) 645-6990
Entity
Organization
Contact information
Practice address
2690 MADISON STREET, STE 130, CLARKSVILLE, TN 37043-5458
(931) 645-6990
(931) 245-1720
Mailing address
2690 MADISON ST, STE 130, CLARKSVILLE, TN 37043-5975
(931) 645-6990
(931) 245-1720
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
MD45045
TN
363LF0000X
Family Nurse Practitioner
APN15967
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1527840
—
TN
01
—
4324612
BCBSTN
TN
Enumeration date
11/12/2011
Last updated
06/20/2012
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