Healthcare Provider Details

I. General information

NPI: 1326031071
Provider Name (Legal Business Name): JOHN F JERNIGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OAK RIDGE TPKE SUITE C-100
OAK RIDGE TN
37830-6957
US

IV. Provider business mailing address

800 OAK RIDGE TPKE SUITE C-100
OAK RIDGE TN
37830-6957
US

V. Phone/Fax

Practice location:
  • Phone: 865-423-8822
  • Fax: 865-482-4400
Mailing address:
  • Phone: 865-423-8822
  • Fax: 865-482-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number9533
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: