Healthcare Provider Details

I. General information

NPI: 1851093843
Provider Name (Legal Business Name): B MAXWELL JUMP DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E MAIN ST STE 200
CHATTANOOGA TN
37408-1609
US

IV. Provider business mailing address

320 E MAIN ST STE 200
CHATTANOOGA TN
37408-1609
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 Code207R00000X
TaxonomyInternal Medicine Physician
License Number7031
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: