Healthcare Provider Details

I. General information

NPI: 1316001282
Provider Name (Legal Business Name): JACQUELINE LOU AYERS D.PH., CGP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 EXECUTIVE PARK DR SUITE A-204
KNOXVILLE TN
37923-4685
US

IV. Provider business mailing address

12215 MOSSY POINT WAY
KNOXVILLE TN
37922-0610
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-0008
  • Fax: 865-531-8990
Mailing address:
  • Phone: 865-250-9326
  • Fax: 865-531-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number4139
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberRPH016382
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number0202013044
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: