Provider Demographics
NPI:1679585822
Name:RETIEF, CARLA R (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:R
Last Name:RETIEF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4301 HILLSBORO PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3345
Mailing Address - Country:US
Mailing Address - Phone:615-383-6092
Mailing Address - Fax:615-292-8424
Practice Address - Street 1:4301 HILLSBORO PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-3345
Practice Address - Country:US
Practice Address - Phone:615-383-6092
Practice Address - Fax:615-292-8424
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD34844207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN300033OtherUNITED HEALTHCARE
TN4018364OtherBLUECROSS BLUESHIELD
TN7831036OtherAETNA
TN4018364OtherBLUECROSS BLUESHIELD
G95306Medicare UPIN