- Completed credentialing application
- Current signed attestation page (date must not be more than 45 days old)
- W-9
- Current malpractice insurance
- Current state license(s)
- Current DEA certificate
- Current CDS/DPS certificate (if applicable)
- Current board certification (if applicable)
- Certificate of completion for highest level of professional education (if not board certified)
These items may be sent in via e-mail to credentialing@primehealthservices.com, fax at 615-329-4751 or mail at 331 Mallory Station Rd. Franklin, TN 37067.
Failure to provide the above mentioned items will result in the delay of the provider being listed in the directory and possibly the termination and reporting of provider to necessary authorities.