Healthcare Provider Details

I. General information

NPI: 1851911515
Provider Name (Legal Business Name): AMY LYNN JARRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 TIMBER RIDGE DR
HIXSON TN
37343-3882
US

IV. Provider business mailing address

621 TIMBER RIDGE DR
HIXSON TN
37343-3882
US

V. Phone/Fax

Practice location:
  • Phone: 706-349-1182
  • Fax: 706-820-5521
Mailing address:
  • Phone: 706-349-1182
  • Fax: 706-820-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-57527
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: