Healthcare Provider Details

I. General information

NPI: 1346250644
Provider Name (Legal Business Name): FAMILY MEDICINE OF JONESBOROUGH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 E JACKSON BLVD SUITE 8
JONESBOROUGH TN
37659-1546
US

IV. Provider business mailing address

806 E JACKSON BLVD SUITE 8
JONESBOROUGH TN
37659-1546
US

V. Phone/Fax

Practice location:
  • Phone: 423-788-0123
  • Fax: 423-788-0124
Mailing address:
  • Phone: 423-788-0123
  • Fax: 423-788-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL E JEWETT
Title or Position: PRESIDENT
Credential: MD
Phone: 423-788-0123