Healthcare Provider Details

I. General information

NPI: 1760397004
Provider Name (Legal Business Name): MARY JAMERSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 DECATUR PIKE
ATHENS TN
37303-3039
US

IV. Provider business mailing address

1019 DECATUR PIKE
ATHENS TN
37303-3039
US

V. Phone/Fax

Practice location:
  • Phone: 423-746-5973
  • Fax:
Mailing address:
  • Phone: 931-253-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number42550
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: