Healthcare Provider Details

I. General information

NPI: 1871076661
Provider Name (Legal Business Name): JAYESH BHARATBHAI PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2018
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
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: 931-490-7775
  • Fax: 931-490-7797
Mailing address:
  • Phone: 931-490-7775
  • Fax: 931-490-7797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberR-11389
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number77803
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: