Healthcare Provider Details

I. General information

NPI: 1306917117
Provider Name (Legal Business Name): JASON WAYNE POLLOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 GARRISON DR
MURFREESBORO TN
37129-2598
US

IV. Provider business mailing address

1272 GARRISON DR.
MURFREESBORO TN
37129
US

V. Phone/Fax

Practice location:
  • Phone: 615-867-7833
  • Fax: 615-848-1182
Mailing address:
  • Phone: 615-867-7833
  • Fax: 615-848-1182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number1000256367
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD00000050049
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: