Ladonia T Atwater, AG-ACNP
Individual provider Active NPI Gerontology Nurse Practitioner · Brentwood, TN
NPI 1316635261 · NPPES record last updated Jul 31, 2023
Key facts
- NPI
- 1316635261
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Nurse Practitioner 363LG0600X
- License
- 242209 (TN)
- Practice address
- 330 Franklin Rd Ste 135-A270
Brentwood, TN 37027-3280 - Phone
- (615) 274-9767
- Fax
- (615) 807-4811
- NPI assigned
- Apr 28, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Southeastern Physician Services PC
Practice addresses (Care Compare)
651 Dunlop LN
Clarksville, TN 37040-5015
Phone (931) 502-1370
Hospital & facility affiliations
- Vanderbilt Clarksville Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230621000646 | TN | Practitioner - Nurse Practitioner | 0547628752 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 242209 | TN | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iris Medical Group | Current |
Accepting new patients | |
| Southeastern Physician Services PC | Current |
Accepting new patients | |
| Iris Medical Group Kentucky LLC | Current |
Accepting new patients | |
| Iris Wound Care, PC | Past | Accepting new patients |
Locations
9019 Overlook Blvd
Ste C1B
Brentwood, TN 37027
651 Dunlop Ln
Clarksville, TN 37040
Phone (931) 502-1000
1201 Bishop St
Union City, TN 38261
Phone (423) 698-6061
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 242209 | TN | |
| Adult Health Nurse Practitioner | 363LA2200X | 242209 | TN | |
| Gerontology Nurse Practitioner | 363LG0600X | 242209 | TN | Yes |
Addresses
Primary practice location
330 Franklin Rd Ste 135-A270
Brentwood, TN 37027-3280
Mailing address
4930 Albright Rd
Clarksville, TN 37043-7712
Phone (240) 432-4921
Other providers in Brentwood, TN
- Jill M Aston
- Sharon Tolentino Atienza
- Audrey Hudson Atkins
- Atop Behavioral Health Clinic LLC
- Wendy Anderson Attmore
- Charles H Aust Jr.
- Alex Avary
- Ariel Aveo
- Avery Investments of Nashville, LLC
- Connie Avery
All providers in Brentwood, TN · Gerontology Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 31, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.