Healthcare Provider Details

I. General information

NPI: 1114508694
Provider Name (Legal Business Name): JACOB DANIEL SCHULTZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 21ST AVE S STE 4200
NASHVILLE TN
37232-8774
US

IV. Provider business mailing address

1215 21ST AVE S STE 4200
NASHVILLE TN
37232-8774
US

V. Phone/Fax

Practice location:
  • Phone: 615-936-0100
  • Fax: 615-875-1915
Mailing address:
  • Phone: 615-936-0100
  • Fax: 615-875-1915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: