Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 60409 | TN |
NPI | 1851821649 |
---|---|
Provider Name | Mr. Louis Reginald Lerebours JR. |
First Address | Nashville, TN 37208-1954 |
Second Address | Nashville, TN 37217-3937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 04/10/2021 |