Healthcare Provider Details

I. General information

NPI: 1790956167
Provider Name (Legal Business Name): CENTER FOR INTEGRATIVE MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E 3RD ST SUITE G-100
CHATTANOOGA TN
37403-2201
US

IV. Provider business mailing address

1100 E 3RD ST SUITE G-100
CHATTANOOGA TN
37403-2201
US

V. Phone/Fax

Practice location:
  • Phone: 423-643-2246
  • Fax: 423-643-2030
Mailing address:
  • Phone: 423-643-2246
  • Fax: 423-643-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD28299
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD36510
License Number StateTN

VIII. Authorized Official

Name: DR. JEFFREY S JUMP
Title or Position: DIRECTOR
Credential: M.D.
Phone: 423-643-2000