Healthcare Provider Details

I. General information

NPI: 1306027495
Provider Name (Legal Business Name): JEANNE STEWART JEMISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2007
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 SHELBY VIEW DR STE 101
MEMPHIS TN
38134-7659
US

IV. Provider business mailing address

6400 SHELBY VIEW DR STE 101
MEMPHIS TN
38134-7659
US

V. Phone/Fax

Practice location:
  • Phone: 901-516-1600
  • Fax:
Mailing address:
  • Phone: 901-516-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0000014866
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number0000014866
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: