Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC0000001896 | TN |
NPI | 1104986249 |
---|---|
Provider Name | Robert Mabry |
First Address | Nashville, TN 37219-2320 |
Second Address | Nashville, TN 37219-2320 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/07/2007 |