Provider Demographics
NPI:1407886955
Name:CHISHOLM, JOE M (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:M
Last Name:CHISHOLM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2010 CHURCH ST
Mailing Address - Street 2:MID STATE MEDICAL CENTER SUITE 705
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2012
Mailing Address - Country:US
Mailing Address - Phone:615-329-7930
Mailing Address - Fax:
Practice Address - Street 1:2010 CHURCH ST
Practice Address - Street 2:MID STATE MEDICAL CENTER SUITE 705
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2012
Practice Address - Country:US
Practice Address - Phone:615-329-7930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN007758207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP34422OtherUNITED HEALTHCARE
0025540OtherBLUE CROSS
CSP053OtherCIGNA
D32200Medicare UPIN
OP34422OtherUNITED HEALTHCARE