Healthcare Provider Details

I. General information

NPI: 1831872514
Provider Name (Legal Business Name): JAMESLYNN WAYNE HAEFELE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/10/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 OLD HICKORY BLVD
HERMITAGE TN
37076-2592
US

IV. Provider business mailing address

241 PRYOR DR
GALLATIN TN
37066-5062
US

V. Phone/Fax

Practice location:
  • Phone: 615-857-3076
  • Fax:
Mailing address:
  • Phone: 615-574-9645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number0000003583
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: