Healthcare Provider Details

I. General information

NPI: 1033180948
Provider Name (Legal Business Name): KEITH DOUGLAS NORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 STONEBRIDGE BLVD
JACKSON TN
38305-3830
US

IV. Provider business mailing address

111 STONEBRIDGE BLVD
JACKSON TN
38305-3931
US

V. Phone/Fax

Practice location:
  • Phone: 731-427-7888
  • Fax: 731-265-4159
Mailing address:
  • Phone: 731-427-7888
  • Fax: 731-265-4152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD0000026655
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: