Healthcare Provider Details

I. General information

NPI: 1235178971
Provider Name (Legal Business Name): TONIA L JACKSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 05/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6444 RIVERPLACE DR
NASHVILLE TN
37221-6546
US

IV. Provider business mailing address

6444 RIVERPLACE DR
NASHVILLE TN
37221-6546
US

V. Phone/Fax

Practice location:
  • Phone: 615-496-5383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD0000037269
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number37269
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: