Provider Demographics
NPI:1336124080
Name:SALT, NICHOLAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:SALT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6800 HARRISON PARK DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:TN
Mailing Address - Zip Code:37341-9621
Mailing Address - Country:US
Mailing Address - Phone:423-344-7095
Mailing Address - Fax:423-344-7569
Practice Address - Street 1:6800 HARRISON PARK DR
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:TN
Practice Address - Zip Code:37341-9621
Practice Address - Country:US
Practice Address - Phone:423-344-7095
Practice Address - Fax:423-344-7569
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2010-05-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN26674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3093217Medicare PIN