Provider Demographics
NPI:1043896442
Name:DELALLA, JACOB NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:JACOB
Middle Name:NICHOLAS
Last Name:DELALLA
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:4220 HARDING PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-2005
Mailing Address - Country:US
Mailing Address - Phone:615-222-6977
Mailing Address - Fax:615-222-5322
Practice Address - Street 1:4220 HARDING PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2005
Practice Address - Country:US
Practice Address - Phone:615-222-6977
Practice Address - Fax:615-222-5322
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN71891207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine