MEDICARE: JADA CUNNINGHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	36609	TN

General Provider Information

NPI Number	:	1043846025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADA CUNNINGHAM

Provider Business Mailing Address
First Line	:	9435 S NORTHSHORE DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6550
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9435 S NORTHSHORE DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-6550
Country	:	US
Telephone Number	:	865-769-2180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2020
Last Update Date	:	03/21/2020

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Directions to “ JADA CUNNINGHAM ” Practice Location

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