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General NPI Number Information
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NPI Number | 1346214665
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Entity Type | Individual
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Provider Name | EDWARD L JACOBSON MD
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Gender | Male
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 961 SPRING CREEK RD GALEN MEDICAL GROUP
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City | CHATTANOOGA
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State | TN
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Zip | 37412
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Country | US
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Telephone | 423-892-2221
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Fax | 423-490-3407
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Provider Business Mailing Address
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Address Line | PO BOX 1030 GALEN MEDICAL GROUP
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City | CHATT
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State | TN
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Zip | 37401
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Country | US
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Telephone | 423-894-3725
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Fax | 423-954-9019
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 28164
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License Number State | TN
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