Provider Demographics
NPI:1295782167
Name:FONTENOT, NIGEL M (MD)
Entity type:Individual
Prefix:
First Name:NIGEL
Middle Name:M
Last Name:FONTENOT
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 1:165 CHARLESTON PARK
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-4703
Mailing Address - Country:US
Mailing Address - Phone:615-364-7472
Mailing Address - Fax:
Practice Address - Street 1:UNITY MEDICAL CENTER
Practice Address - Street 2:482 INTERSTATE DRIVE
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355
Practice Address - Country:US
Practice Address - Phone:931-450-1730
Practice Address - Fax:931-461-7086
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20399207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNE90239Medicaid
TN4120635OtherBLUE CROSS
TNP00296999OtherMEDICARE RAILROAD
TN3057116Medicaid
TN3057116Medicare PIN