Individual
MR. CASWELL MILES JEFFERSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SLP
Contact information
Practice address
3601 THE VANDERBILT CLINIC, NASHVILLE, TN 37232-2940
(615) 322-3000
Mailing address
3841 GREEN HILLS VILLAGE DR STE 200, NASHVILLE, TN 37215-2691
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
0000004021
TN
235Z00000X
Speech-Language Pathologist
SLP006493
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
571152749
TRICARE
GA
01
—
766969817A
PEACHSTATE
GA
05
—
766969817A
—
GA
01
—
PENDING
WELLCARE
GA
Enumeration date
04/11/2007
Last updated
03/21/2022
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