Provider Demographics
NPI:1083611651
Name:JAMISON, DALE H JR (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:H
Last Name:JAMISON
Suffix:JR
Gender:M
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:PO BOX 306345
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6401
Mailing Address - Country:US
Mailing Address - Phone:615-969-8141
Mailing Address - Fax:
Practice Address - Street 1:713 ROANTREE DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027
Practice Address - Country:US
Practice Address - Phone:615-969-8141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN017205174400000X
TN17205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3031591OtherBCBS PROVIDER NUMBER
TN3021509Medicaid
AL009992585Medicaid
KY64911720Medicaid
TN3031591OtherBCBS PROVIDER NUMBER
AL009992585Medicaid