Basic Information
| Provider Information | |||||||||
| NPI: | 1346277324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HINDS | ||||||||
| FirstName: | JACKIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2020 21ST AVE S, SUITE 201 | ||||||||
| Address2: | ESN | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152690652 | ||||||||
| FaxNumber: | 6152690135 | ||||||||
| Practice Location | |||||||||
| Address1: | 651 DUNLOP LN. | ||||||||
| Address2: | GATEWAY MED CENTER | ||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370405015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9315021370 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 08/22/2011 | ||||||||
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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 | 207P00000X | A85713 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 44991 | TN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A857130 | 05 | CA | MEDICAID |