Healthcare Provider Details

I. General information

NPI: 1194775155
Provider Name (Legal Business Name): JULIE A JACQUES DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 W MORRIS BLVD HEALTHSTAR PHYSICIANS STE G
MORRISTOWN TN
37813
US

IV. Provider business mailing address

1907 W MORRIS BLVD HEALTHSTAR PHYSICIANS STE G
MORRISTOWN TN
37813
US

V. Phone/Fax

Practice location:
  • Phone: 423-318-0014
  • Fax: 423-318-2595
Mailing address:
  • Phone: 423-318-0014
  • Fax: 423-318-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberDO1497
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberDO1497
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: