Jack Coleman Fisher, D.M.D

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

4275 Issued in TN

Practice address

8295 Cordova Rd
Suite 101
Cordova, TN 38016-2045

Phone

(901) 433-9181

Fax

(901) 433-9170

NPI assigned

Nov 15, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jack Coleman Fisher Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331769600000",
    "number": "1609948363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8295 CORDOVA RD",
            "address_2": "SUITE 101",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380162045",
            "telephone_number": "901-433-9181",
            "fax_number": "901-433-9170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8295 CORDOVA RD",
            "address_2": "SUITE 101",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380162045",
            "telephone_number": "901-433-9181",
            "fax_number": "901-433-9170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHER",
        "first_name": "JACK",
        "middle_name": "COLEMAN",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2012-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TN",
            "license": "4275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACK",
            "last_name": "FISHER",
            "middle_name": "COLEMAN",
            "credential": "D.M.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Janet Lee Ferrell, LPC
• Heather Nichole Fesperman, PMHNP-BC.
• Justice Briana Fields, RBT
• Katisha Fields
• First Pharmacy Services of Country Village
• Terrence Deshon Fisher
• Victoria Brooks Fisher, OT
• Sandra K Fletchall, OTRL,CHT,FAOTA,MPA
• Sidney Truman Fletcher, DDS
• Gradnette Fluker, LMSW

• Orthodontics and Dentofacial Orthopedics Dentistry in Cordova, TN
• Providers in Cordova, TN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.