Healthcare Provider Details

I. General information

NPI: 1124544903
Provider Name (Legal Business Name): EMILY J JALLAH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GREEN CHAPEL RD
HENNING TN
38041-5726
US

IV. Provider business mailing address

480 GREEN CHAPEL RD
HENNING TN
38041-5726
US

V. Phone/Fax

Practice location:
  • Phone: 901-844-1434
  • Fax:
Mailing address:
  • Phone: 901-844-1434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number22958
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: