MEDICARE: TYLER JOHN MCKINNON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	191928	NC
2	2085R0202X	Diagnostic Radiology Physician	56340	TN
3	2085R0202X	Diagnostic Radiology Physician	90901	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205272408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER JOHN MCKINNON MD

Provider Business Mailing Address
First Line	:	719 THOMPSON LN STE 30330
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37204-4701
Country	:	US
Telephone Number	:	615-322-3000
Fax Number	:	615-322-3000

Provider Business Practice Location Address
First Line	:	1161 21ST AVE S STE CCC 1118
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-2134
Country	:	US
Telephone Number	:	615-322-3000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2013
Last Update Date	:	06/09/2022

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