| NPI | 1912184755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L JACKSON Sr. Director Of Provider Enrollment 615-465-3334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2021-10-01 |