Healthcare Provider Details

I. General information

NPI: 1871570903
Provider Name (Legal Business Name): SANFORD JONATHAN LAX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 NASHVILLE PIKE STE 100
GALLATIN TN
37066-3154
US

IV. Provider business mailing address

1720 NASHVILLE PIKE STE 100
GALLATIN TN
37066-3154
US

V. Phone/Fax

Practice location:
  • Phone: 615-230-8601
  • Fax: 615-230-8670
Mailing address:
  • Phone: 615-230-8601
  • Fax: 615-230-8670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301407434
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number59735
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: