Provider Demographics
NPI:1043283427
Name:HASELTON, DANA J (MD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:J
Last Name:HASELTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 PRESIDENT PL
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-8603
Mailing Address - Country:US
Mailing Address - Phone:615-459-5252
Mailing Address - Fax:
Practice Address - Street 1:699 PRESIDENT PL
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-8603
Practice Address - Country:US
Practice Address - Phone:615-459-5252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN031920208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440730Medicaid
TN5440730Medicaid