Healthcare Provider Details

I. General information

NPI: 1841936739
Provider Name (Legal Business Name): JAHN OSVALDO ACEVEDO-ORTIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 05/24/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 BROADWAY ST
SOUTH FULTON TN
38257-2835
US

IV. Provider business mailing address

312 PANOLA DR
MARTIN TN
38237-2508
US

V. Phone/Fax

Practice location:
  • Phone: 731-479-2606
  • Fax:
Mailing address:
  • Phone: 787-317-8060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAJ1165667-237
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: