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General NPI Number Information
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NPI Number | 1972852341
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Entity Type | Organization
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Legal Business Name | JTP ENTERPRISES, LLC
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 01/23/2014
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Provider Practice Location Address
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Address Line | 287 TURNTABLE RD.
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City | SPARTA
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State | TN
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Zip | 38583
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Country | US
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Telephone | 931-738-2000
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Fax | 888-337-7080
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Provider Business Mailing Address
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Address Line | 287 TURNTABLE RD.
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City | SPARTA
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State | TN
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Zip | 38583
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Country | US
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Telephone | 931-738-2000
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Fax | 888-337-7080
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Authorized Official
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Title or Position | CEO
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Name | JERRY W PERNELL
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Credential | CFNP
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Telephone | 931-707-7117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 7811
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 7811
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License Number State | TN
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