Healthcare Provider Details

I. General information

NPI: 1225679376
Provider Name (Legal Business Name): JIMMY HUGHES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 10/10/2020
Certification Date: 10/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9177 INTEGRA PRESERVE CT # 8
OOLTEWAH TN
37363-4541
US

IV. Provider business mailing address

2372 LIFESTYLE WAY STE 152
CHATTANOOGA TN
37421-4940
US

V. Phone/Fax

Practice location:
  • Phone: 423-902-4236
  • Fax:
Mailing address:
  • Phone: 423-894-0432
  • Fax: 423-894-0475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN000026436
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: