Provider Demographics
NPI:1386718302
Name:GALLATIN SURGICAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:GALLATIN SURGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-451-7706
Mailing Address - Street 1:300 STEAM PLANT RD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3032
Mailing Address - Country:US
Mailing Address - Phone:615-451-7706
Mailing Address - Fax:615-451-7708
Practice Address - Street 1:300 STEAM PLANT RD
Practice Address - Street 2:SUITE 470
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3032
Practice Address - Country:US
Practice Address - Phone:615-451-7706
Practice Address - Fax:615-451-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38253208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7824568OtherAETNA
TN9466849OtherCIGNA
TN2241512OtherFIRST HEALTH
TN4087130OtherBCBS
TN3726525Medicare ID - Type UnspecifiedMEDICARE
TN9466849OtherCIGNA