Provider Demographics
NPI:1295379568
Name:POLLOCK, ZACHARY (PA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 MADISON ST STE 130
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-6185
Mailing Address - Country:US
Mailing Address - Phone:931-245-1701
Mailing Address - Fax:931-245-1720
Practice Address - Street 1:2690 MADISON ST STE 130
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6185
Practice Address - Country:US
Practice Address - Phone:931-245-1701
Practice Address - Fax:931-245-1720
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3973363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3973OtherPA