Provider Demographics
NPI:1285688457
Name:HAZLEY, ANDREW J
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:J
Last Name:HAZLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2450
Mailing Address - Country:US
Mailing Address - Phone:615-895-3890
Mailing Address - Fax:615-895-0941
Practice Address - Street 1:1009 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2450
Practice Address - Country:US
Practice Address - Phone:615-895-3890
Practice Address - Fax:615-895-0941
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000013211208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3715782Medicaid
TN3715782Medicare ID - Type Unspecified
TN3715782Medicaid