Healthcare Provider Details

I. General information

NPI: 1215998612
Provider Name (Legal Business Name): JESSE E SCRUGGS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING RD SUITE 435
NASHVILLE TN
37205-2013
US

IV. Provider business mailing address

4230 HARDING RD SUITE 435
NASHVILLE TN
37205-2013
US

V. Phone/Fax

Practice location:
  • Phone: 615-385-3704
  • Fax: 615-292-1321
Mailing address:
  • Phone: 615-385-3704
  • Fax: 615-292-1321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD39345
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number48446
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: