Basic Information
| Provider Information | |||||||||
| NPI: | 1063837813 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARTWRIGHT | ||||||||
| FirstName: | JORDAN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 GREAT CIRCLE RD | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372281317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153297878 | ||||||||
| FaxNumber: | 6153297899 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 CHURCH ST | ||||||||
| Address2: | STE. 700 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372032012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153297878 | ||||||||
| FaxNumber: | 6153297899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2014 | ||||||||
| LastUpdateDate: | 02/16/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2775 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | 2775 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | APPLIED FOR | 01 | TN | BCBST | OTHER | APPLIED FOR | 01 | TN | RR MEDICARE | OTHER | APPLIED FOR | 05 | TN | MEDICAID |