Healthcare Provider Details

I. General information

NPI: 1508830407
Provider Name (Legal Business Name): BRIAN KEITH JEFFERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 02/09/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 PATTERSON ST SUITE 502
NASHVILLE TN
37203-1562
US

IV. Provider business mailing address

2400 PATTERSON ST SUITE 502
NASHVILLE TN
37203-1562
US

V. Phone/Fax

Practice location:
  • Phone: 615-515-1900
  • Fax: 615-515-1993
Mailing address:
  • Phone: 615-515-1900
  • Fax: 615-515-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42338
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number42338
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number42338
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: