Healthcare Provider Details

I. General information

NPI: 1205016060
Provider Name (Legal Business Name): JAMAL GERGES MAATOUK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

378 MARKETPLACE BLVD STE 6
JOHNSON CITY TN
37604-2361
US

IV. Provider business mailing address

2004 HAYES ST STE 800
NASHVILLE TN
37203-2659
US

V. Phone/Fax

Practice location:
  • Phone: 423-656-0716
  • Fax:
Mailing address:
  • Phone: 615-329-0570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number46076
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: