=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912144726
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT RICHARD JOLMAN PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2009
-----------------------------------------------------
Last Update Date | 07/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 S GATEWAY BLVD
-----------------------------------------------------
City | CLARKSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37043-8118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-552-4340
-----------------------------------------------------
Fax | 931-552-0999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 306556
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37230-6556
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-329-2294
-----------------------------------------------------
Fax | 615-695-1494
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 4918
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------