Healthcare Provider Details

I. General information

NPI: 1487578506
Provider Name (Legal Business Name): JEREMY JENNINGS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 DESALES AVE
CHATTANOOGA TN
37404-1161
US

IV. Provider business mailing address

4974 MCCAHILL RD
CHATTANOOGA TN
37415-1706
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-2525
  • Fax:
Mailing address:
  • Phone: 864-280-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number210768
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: