Healthcare Provider Details

I. General information

NPI: 1407182157
Provider Name (Legal Business Name): JOJY JOB PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W KINGSTON SPRINGS RD STE 104
KINGSTON SPRINGS TN
37082-9121
US

IV. Provider business mailing address

3024 BUSINESS PARK CIR
GOODLETTSVILLE TN
37072-3132
US

V. Phone/Fax

Practice location:
  • Phone: 615-590-8000
  • Fax:
Mailing address:
  • Phone: 615-239-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3670
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: