Healthcare Provider Details

I. General information

NPI: 1750593208
Provider Name (Legal Business Name): JACQUELYN ANN EARLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2007
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16000 JOHNSTON MEMORIAL DR EMERGENCY DEPARTMENT
ABINGDON VA
24211-7659
US

IV. Provider business mailing address

16000 JOHNSTON MEMORIAL DR EMERGENCY DEPARTMENT
ABINGDON VA
24211-7659
US

V. Phone/Fax

Practice location:
  • Phone: 276-258-1100
  • Fax: 276-258-1125
Mailing address:
  • Phone: 276-258-1100
  • Fax: 276-258-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2007-00248
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101247123
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: