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General NPI Number Information
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NPI Number | 1740639962
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Entity Type | Organization
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Legal Business Name | JABBOK TREATMENT CENTER, LLC.
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 40 IRWIN ST
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City | SAVANNAH
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State | TN
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Zip | 38372-3084
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Country | US
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Telephone | 731-727-5603
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Fax | 731-925-2114
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Provider Business Mailing Address
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Address Line | 40 IRWIN ST
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City | SAVANNAH
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State | TN
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Zip | 38372-3084
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Country | US
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Telephone | 731-727-5603
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Fax | 731-925-2114
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Authorized Official
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Title or Position | OWNER/COO
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Name | JACQUELINE D IRWIN
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Credential |
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Telephone | 77316167753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 207QA0401X
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License Number State | TN
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