Healthcare Provider Details

I. General information

NPI: 1063407773
Provider Name (Legal Business Name): JANA K DREYZEHNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 HOSPITAL DR
CLINTWOOD VA
24228-6786
US

IV. Provider business mailing address

415 CHURCH ST #2802
NASHVILLE TN
37219-2308
US

V. Phone/Fax

Practice location:
  • Phone: 276-356-5262
  • Fax: 615-523-1589
Mailing address:
  • Phone: 276-356-5262
  • Fax: 615-523-1589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101055915
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD0000029394
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: