Healthcare Provider Details

I. General information

NPI: 1639696362
Provider Name (Legal Business Name): JONATHAN RAJ PAUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 TROTWOOD AVE
COLUMBIA TN
38401-4802
US

IV. Provider business mailing address

1224 TROTWOOD AVE
COLUMBIA TN
38401-4802
US

V. Phone/Fax

Practice location:
  • Phone: 931-381-1111
  • Fax:
Mailing address:
  • Phone: 931-381-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301503379
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number71718
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number71718
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: