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General NPI Number Information
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NPI Number | 1538494273
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Entity Type | Individual
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Provider Name | JEROME H MORTON
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Gender | Male
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Dates
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Enumeration Date | 10/14/2009
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 349 BMH PHYSICIANS OFFICE BLDG
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City | MARYVILLE
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State | TN
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Zip | 37804-5820
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Country | US
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Telephone | 865-982-3000
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Fax | 865-212-5597
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Provider Business Mailing Address
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Address Line | 7309 BONNY KATE DR
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City | KNOXVILLE
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State | TN
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Zip | 37920-9552
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Country | US
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Telephone | 865-273-1752
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Fax | 865-273-1755
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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 | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | P0000000266
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | P0000000266
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License Number State | TN
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