Provider Demographics
NPI:1619923547
Name:GASTROENTEROLOGY CONSULTANTS OF MIDDLE TENNESSEE, PLLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS OF MIDDLE TENNESSEE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROTKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-831-5422
Mailing Address - Street 1:397 WALLACE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-4854
Mailing Address - Country:US
Mailing Address - Phone:615-831-5422
Mailing Address - Fax:615-831-7128
Practice Address - Street 1:397 WALLACE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-4854
Practice Address - Country:US
Practice Address - Phone:615-831-5422
Practice Address - Fax:615-831-7128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3725636Medicaid
TN3725636Medicaid