MEDICARE: DR. JACOB RICHARD RADFORD M.D.

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	207P00000X	Emergency Medicine Physician	R2347	KY
2	2083A0300X	Addiction Medicine (Preventive Medicine) Physician	49653	TN
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207P00000X	Emergency Medicine Physician	49653	TN

General Provider Information

NPI Number	:	1710207436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACOB RICHARD RADFORD M.D.

Provider Business Mailing Address
First Line	:	3443 DICKERSON PIKE STE 310
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37207-2523
Country	:	US
Telephone Number	:	615-645-3013
Fax Number	:	615-621-3158

Provider Business Practice Location Address
First Line	:	3443 DICKERSON PIKE STE 310
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37207-2523
Country	:	US
Telephone Number	:	615-645-3013
Fax Number	:	615-621-3158

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

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	05/01/2025

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