Healthcare Provider Details

I. General information

NPI: 1154647188
Provider Name (Legal Business Name): COLT MCCLAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 HARDING PIKE
NASHVILLE TN
37205-2005
US

IV. Provider business mailing address

2010 CHURCH ST SUITE 615
NASHVILLE TN
37203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 615-222-3047
  • Fax: 615-222-3702
Mailing address:
  • Phone: 615-284-7950
  • Fax: 615-284-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number50564
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number50564
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: