MEDICARE: JEFFERY CARL ANDERSON 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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1558120733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY CARL ANDERSON MD

Provider Business Mailing Address
First Line	:	1161 21ST AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-2675
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1161 21ST AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-1352
Country	:	US
Telephone Number	:	615-322-0999
Fax Number	:

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

Provider Enumeration Date	:	03/18/2024
Last Update Date	:	06/25/2025

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