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General NPI Number Information
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NPI Number | 1275777682
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Entity Type | Individual
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Provider Name | AMELIA MARIE JERNIGAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 9500 EUCLID AVE DESK A81
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City | CLEVELAND
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State | OH
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Zip | 44195-0001
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Country | US
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Telephone | 216-445-2358
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Fax |
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Provider Business Mailing Address
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Address Line | 1542 TULANE AVE FL 5
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City | NEW ORLEANS
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State | LA
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Zip | 70112-2865
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Country | US
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Telephone | 504-568-4850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 24367
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 301195
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 207VX0201X
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Taxonomy Name | Gynecologic Oncology Physician
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License Number | 35.121409
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License Number State | OH
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