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General NPI Number Information
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NPI Number | 1780648063
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Entity Type | Individual
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Provider Name | MICHAEL E JEWETT M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 01/14/2011
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Provider Practice Location Address
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Address Line | 121 E MAIN ST
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City | JONESBOROUGH
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State | TN
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Zip | 37659-1317
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Country | US
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Telephone | 423-788-0123
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Fax | 866-212-2654
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Provider Business Mailing Address
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Address Line | PO BOX 556
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City | JONESBOROUGH
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State | TN
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Zip | 37659-0556
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Country | US
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Telephone | 423-788-0123
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Fax | 866-212-2654
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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 | MD37121
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License Number State | TN
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