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General NPI Number Information
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NPI Number | 1417080847
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Entity Type | Individual
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Provider Name | JAIME SUE THREADGILL D.PH.
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Gender | Female
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 110 N MARKET ST
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City | CHATTANOOGA
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State | TN
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Zip | 37405-3905
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Country | US
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Telephone | 423-752-8104
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Fax |
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Provider Business Mailing Address
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Address Line | 1210 DUGDALE ST
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City | CHATTANOOGA
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State | TN
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Zip | 37405-3620
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Country | US
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Telephone | 423-752-8418
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5923
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number | 5923
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 1835N1003X
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Taxonomy Name | Nutrition Support Pharmacist
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License Number | 5923
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 5923
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | 5923
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License Number State | TN
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