Basic Information
| Provider Information | |||||||||
| NPI: | 1770630667 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COLFAX | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DREW | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE VANTAGE WAY | ||||||||
| Address2: | SUITE B240 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153294020 | ||||||||
| FaxNumber: | 6153299479 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 NORTH HIGHLAND AVENUE | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6155963455 | ||||||||
| FaxNumber: | 6153966963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 03/24/2008 | ||||||||
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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 | 207P00000X | 42461 | TN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3000317 | 05 | TN | MEDICAID |