Provider Demographics
NPI:1356404859
Name:DONNELLY, JENNIFER M (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5505 EDMONDSON PIKE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5872
Mailing Address - Country:US
Mailing Address - Phone:615-331-5898
Mailing Address - Fax:615-331-5705
Practice Address - Street 1:5505 EDMONDSON PIKE
Practice Address - Street 2:SUITE 104
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-5872
Practice Address - Country:US
Practice Address - Phone:615-331-5898
Practice Address - Fax:615-331-5705
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD30681208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3897814Medicaid
G89306Medicare UPIN