Basic Information
Provider Information
NPI: 1003010588
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLACK
FirstName: ENGLISH
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2200 CHILDRENS WAY
Address2: SUITE 5230
City: NASHVILLE
State: TN
PostalCode: 372329119
CountryCode: US
TelephoneNumber: 6153227447
FaxNumber:  
Practice Location
Address1: 2200 CHILDRENS WAY
Address2: SUITE 5230
City: NASHVILLE
State: TN
PostalCode: 372329119
CountryCode: US
TelephoneNumber: 6153227447
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/11/2007
LastUpdateDate: 03/24/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0202X46401TNY Allopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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