Provider Demographics
NPI:1245237148
Name:FAULK, JIMBOB (MD)
Entity type:Individual
Prefix:
First Name:JIMBOB
Middle Name:
Last Name:FAULK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:410 42ND AVE N STE 400
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-3658
Mailing Address - Country:US
Mailing Address - Phone:615-329-7887
Mailing Address - Fax:615-346-6225
Practice Address - Street 1:4230 HARDING PIKE STE 705
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-385-1547
Practice Address - Fax:615-297-9161
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN355002086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33305621Medicare PIN
TN3330562Medicare PIN
TNI33670Medicare UPIN