Provider Demographics
NPI:1477559094
Name:FITZPATRICK, JERI EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:EILEEN
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 HARDING RD
Mailing Address - Street 2:STE 102
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2120
Mailing Address - Country:US
Mailing Address - Phone:615-269-4557
Mailing Address - Fax:
Practice Address - Street 1:4535 HARDING RD
Practice Address - Street 2:STE 102
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2120
Practice Address - Country:US
Practice Address - Phone:615-269-4557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN188442084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF14350Medicare UPIN