Organization Name: | JONESBOROUGH ADULT & GERIATRIC MEDICINE LLC |
NPI Number: | 1336443555 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ERIKA C JEWETT (PRESIDENT) |
Mailing Address: | 121 E Main St Jonesborough |
State: | TN US |
Postal Code: | 376591317 |
Phone Number: | 4237880123 |
Fax Number: | |
NPI Enumeration Date: | 01/03/2011 |
NPI Last Update Date: | 01/03/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 14866 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |