Individual
MR. JACK MICHAEL FRIDAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3024 BUSINESS PARK CIR, GOODLETTSVILLE, TN 37072-3132
(615) 851-6033
(615) 851-2018
Mailing address
3024 BUSINESS PARK CIR, GOODLETTSVILLE, TN 37072-3132
(615) 851-6033
(615) 851-2018
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD25800
TN
2085R0204X
Vascular & Interventional Radiology Physician
25800
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1509266
MEDICAID - MTI
TN
05
—
1509266
—
TN
01
—
300108653
RAILROAD MEDICARE
TN
01
—
3031174
BCBS
TN
05
—
3083732
—
TN
01
—
3136571
BCBS
TN
01
—
4200799
BCBS TN
TN
01
—
4291356
BCBS - MTI
TN
01
—
64924590
KY MEDICAID
KY
05
—
6492459000
—
KY
Enumeration date
06/05/2006
Last updated
11/30/2011
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