Conrad Renaldo Douglas, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS0000004460 Issued in TN

Practice address

2679 Murfreesboro Pike
Nashville, TN 37217-3505

Phone

(615) 360-3151

Fax

(615) 360-3151

NPI assigned

Feb 12, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1811038615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "329 YORKSHIRE CIR",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372117134",
            "telephone_number": "615-331-4713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2679 MURFREESBORO PIKE",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372173505",
            "telephone_number": "615-360-3151",
            "fax_number": "615-360-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "CONRAD",
        "middle_name": "RENALDO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "DS0000004460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miranda Lee Dougherty
• Douglas M Weissman MD PA
• Amy Louise Douglas-McVay, M.D.
• Aretha Douglas
• Chasity Douglas
• Glenn C Douglas, MD
• Keith Douglas, MD
• Marcia Annette Douglas, MSW
• Rian Douglas
• Taneesha Douglas, CNM APRN

• General Practice Dentistry in Nashville, TN
• Providers in Nashville, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.