Provider Demographics
NPI:1952386393
Name:JACOBS, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:JACOBS
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 1:501 GREAT CIRCLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1317
Mailing Address - Country:US
Mailing Address - Phone:615-222-6977
Mailing Address - Fax:615-222-5322
Practice Address - Street 1:4220 HARDING RD
Practice Address - Street 2:SUITE 500
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2005
Practice Address - Country:US
Practice Address - Phone:615-222-6977
Practice Address - Fax:615-222-5322
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37385207R00000X, 207RC0000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6010930OtherBLUE CROSS-BLUE SHIELD
TN38874641Medicaid
TN4154142OtherBLUE CROSS
TN3887464Medicaid
KY7100052260Medicaid
TN4064306OtherBLUE CROSS BLUE SHIELD
0007460476OtherAETNA
P00400975OtherRAILROAD MEDICARE
TN6010930OtherBLUE CROSS-BLUE SHIELD
TN103I111062Medicare PIN
38874641Medicare PIN
3887464Medicare PIN