Provider Demographics
NPI:1043299464
Name:HOLLIS, JEFFREY DIXON (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DIXON
Last Name:HOLLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:STE 403
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-4088
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:300 STEAM PLANT RD
Practice Address - Street 2:STE. 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38253208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNI7522OtherHEALTHSPRING
TN953233OtherUSA MANAGED CARE
TN2241512OtherFIRST HEALTH
TN4087130OtherBCBS
TN7824568OtherAETNA
TN9466849OtherCIGNA
TN2241512OtherFIRST HEALTH
TNI17522Medicare UPIN