Healthcare Provider Details

I. General information

NPI: 1710413430
Provider Name (Legal Business Name): LOGAN FOX
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JAMES ROBERTSON PKWY
NASHVILLE TN
37201-1202
US

IV. Provider business mailing address

200 JAMES ROBERTSON PKWY
NASHVILLE TN
37201-1202
US

V. Phone/Fax

Practice location:
  • Phone: 615-862-8224
  • Fax:
Mailing address:
  • Phone: 615-862-8224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4588
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: