Basic Information
| Provider Information | |||||||||
| NPI: | 1558541565 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAY | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 STONECREST BLVD STE 230 | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371676800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157308626 | ||||||||
| FaxNumber: | 6158406169 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 STONECREST BLVD STE 230 | ||||||||
| Address2: | |||||||||
| City: | SMYRNA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371676800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157308626 | ||||||||
| FaxNumber: | 6158406169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2007 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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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 | 363AS0400X | PA9104321 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AS0400X | PA1684 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 1512989 | 05 | TN | MEDICAID | 4275164 | 01 | TN | BCBS | OTHER | 4253300 | 01 | TN | BCBS | OTHER |