Healthcare Provider Details

I. General information

NPI: 1538494273
Provider Name (Legal Business Name): JEROME H MORTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 BMH PHYSICIANS OFFICE BLDG
MARYVILLE TN
37804-5820
US

IV. Provider business mailing address

7309 BONNY KATE DR
KNOXVILLE TN
37920-9552
US

V. Phone/Fax

Practice location:
  • Phone: 865-982-3000
  • Fax: 865-212-5597
Mailing address:
  • Phone: 865-273-1752
  • Fax: 865-273-1755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberP0000000266
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberP0000000266
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: