Healthcare Provider Details

I. General information

NPI: 1972852341
Provider Name (Legal Business Name): JTP ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 TURNTABLE RD.
SPARTA TN
38583
US

IV. Provider business mailing address

287 TURNTABLE RD.
SPARTA TN
38583
US

V. Phone/Fax

Practice location:
  • Phone: 931-738-2000
  • Fax: 888-337-7080
Mailing address:
  • Phone: 931-738-2000
  • Fax: 888-337-7080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7811
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number7811
License Number StateTN

VIII. Authorized Official

Name: JERRY W PERNELL
Title or Position: CEO
Credential: CFNP
Phone: 931-707-7117