Basic Information
| Provider Information | |||||||||
| NPI: | 1013285972 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HITCHCOCK | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | CHAD | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 CROSSINGS CIR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MOUNT JULIET | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371228592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157581010 | ||||||||
| FaxNumber: | 6157583875 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 CROSSINGS CIR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | MOUNT JULIET | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371228592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157581010 | ||||||||
| FaxNumber: | 6157583875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2011 | ||||||||
| LastUpdateDate: | 02/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA0000002002 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 6012066 | 01 | TN | BLUE CROSS-BLUE SHIELD | OTHER | P0102693 | 01 | TN | RR MEDICARE | OTHER | 1527481 | 05 | TN | MEDICAID |