Fairhurst Dermatology

Primary specialty

SpecialistTaxonomy code 174400000X

License

36190 Issued in TN

Legal business name

FAIRHURST DERMATOLOGY

Practice address

3040 Business Park Cir
Goodlettsville, TN 37072-3594

Phone

(615) 870-1404

Fax

(615) 870-1454

NPI assigned

Oct 2, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Victor Fairhurst, MD

Title

President/Owner

Phone

(615) 870-1404

Specialties & licenses 1

Addresses

Other identifiers 7

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeffrey Berti, M.D.

  • Dermatology Physician
  • Brentwood, TN
  • NPI 1467476457
  NPD (past)
• Toula Romas Berti, M.D.

  • General Practice Physician
  • Brentwood, TN
  • NPI 1568783363
  NPD (past)
• Callie Graves, PA-C

  • Physician Assistant
  • Spring Hill, TN
  • NPI 1184189219
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363651200000",
    "number": "1114010741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 BUSINESS PARK CIR",
            "city": "GOODLETTSVILLE",
            "state": "TN",
            "postal_code": "370723594",
            "telephone_number": "615-870-1404",
            "fax_number": "615-870-1454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 BUSINESS PARK CIR",
            "city": "GOODLETTSVILLE",
            "state": "TN",
            "postal_code": "370723594",
            "telephone_number": "615-870-1404",
            "fax_number": "615-870-1454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRHURST DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2013-03-19",
        "status": "A",
        "authorized_official_last_name": "FAIRHURST",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "VICTOR",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "615-870-1404",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "TN",
            "license": "36190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNCARE SELECT PROV NUMB",
            "identifier": "4053381",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICAID PROV NU",
            "identifier": "P00010292",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST PROVIDER NUMBER",
            "identifier": "4053381",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHSPRING PROVIDER NUM",
            "identifier": "F27966",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER NUMBER",
            "identifier": "4281928",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE PROVIDER NUMBER",
            "identifier": "50554854",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3714159",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alan Steven Ericksen, M.D.
• Eric Ethridge, DC
• Emily Evans, O.D.
• Philip Wayne Ezell, DDS
• Fair Winds Way, PLLC
• Nauzanene Jafari Fard Veyjoyeh, DDS
• Hal T Farmer, D.C.
• Fast Pace Medical Clinic PLLC
• Robert Guy Ferland, M.D.
• Suzanne L. Field, M.D.

• Specialist in Goodlettsville, TN
• Providers in Goodlettsville, TN by specialty
• Specialist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.