Provider Demographics
NPI:1750494969
Name:LAFFERTY, NATHANAEL L (MD)
Entity Type:Individual
Prefix:
First Name:NATHANAEL
Middle Name:L
Last Name:LAFFERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 W JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4659
Mailing Address - Country:US
Mailing Address - Phone:931-540-4255
Mailing Address - Fax:931-490-4654
Practice Address - Street 1:5421 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2499
Practice Address - Country:US
Practice Address - Phone:931-486-2500
Practice Address - Fax:931-486-3748
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3710089Medicaid
TN4064039OtherBCBSTN
TN3710082Medicaid
TN3885301Medicaid
TN4117768OtherBCBSTN
TNP00024285Medicare PIN
TN3732438Medicare PIN
TN4064039OtherBCBSTN
TN3710082Medicaid
TN3885302Medicare PIN
TN3710089Medicare PIN
TN4117768OtherBCBSTN
TN3885301Medicare PIN