1235163528 NPI number — DR. EDWARD JEFF DINKINS MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235163528 NPI number — DR. EDWARD JEFF DINKINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DINKINS
Provider First Name:
EDWARD
Provider Middle Name:
JEFF
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DINKINS
Provider Other First Name:
JEFF
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1235163528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5653 FRIST BLVD
Provider Second Line Business Mailing Address:
SUITE 630
Provider Business Mailing Address City Name:
HERMITAGE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37076-2062
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-391-3971
Provider Business Mailing Address Fax Number:
615-369-2032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4230 HARDING PIKE STE 900
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37205-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-964-5824
Provider Business Practice Location Address Fax Number:
615-301-7048
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  40522 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 40522 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3816019 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: I161156 . This is a "HEALTH SPRING" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4132096 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P5707573 . This is a "FIRST HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1426139 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 4132096 . This is a "TENNCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 7893843 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: P00355087 . This is a "R/R MCR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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