Healthcare Provider Details

I. General information

NPI: 1831449800
Provider Name (Legal Business Name): CALLIE M JUBRAN RD LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALLIE E MCCAMY RD LDN

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CLINCH AVE #510
KNOXVILLE TN
37916-2219
US

IV. Provider business mailing address

2100 W CLINCH AVE #510
KNOXVILLE TN
37916-2219
US

V. Phone/Fax

Practice location:
  • Phone: 865-546-3998
  • Fax: 865-546-1123
Mailing address:
  • Phone: 865-546-3998
  • Fax: 865-546-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberCDR01047420
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: