MEDICARE: DR. MABBU JAYAKUMAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD0000025230	TN

General Provider Information

NPI Number	:	1063425734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MABBU JAYAKUMAR MD

Provider Business Mailing Address
First Line	:	PO BOX 12484
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38308-0143
Country	:	US
Telephone Number	:	731-512-3812
Fax Number	:	731-512-3813

Provider Business Practice Location Address
First Line	:	168 W UNIVERSITY PKWY STE C
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-1624
Country	:	US
Telephone Number	:	731-512-3812
Fax Number	:	731-512-3813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	04/17/2008

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