Provider Demographics
NPI:1699717033
Name:JEFFREY E. HAZLEWOOD, M.D., P.C.
Entity type:Organization
Organization Name:JEFFREY E. HAZLEWOOD, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HAZLEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-444-3307
Mailing Address - Street 1:PO BOX 2149
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-2149
Mailing Address - Country:US
Mailing Address - Phone:615-444-3307
Mailing Address - Fax:615-444-5579
Practice Address - Street 1:100 PHYSICIANS WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-8102
Practice Address - Country:US
Practice Address - Phone:615-444-3307
Practice Address - Fax:615-444-5579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027823208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4121917OtherBCBS
TN3733565Medicaid
TN3733565Medicare PIN