Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD6483 | TN |
NPI | 1104829340 |
---|---|
Provider Name | Jackson Daniel Cothren |
First Address | Goodlettsville, TN 37072-3132 |
Second Address | Nashville, TN 37203-1864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6066853 | BLUE CROSS BLUE SHIELD (01) | TN |
B02892 | (02) | TN |
Q009775 | (05) | TN |