MEDICARE: JILL C FICHTEL MD

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	207N00000X	Dermatology Physician	35.122022	OH
2	207N00000X	Dermatology Physician	MD39348	TN

General Provider Information

NPI Number	:	1154323749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL C FICHTEL MD

Provider Business Mailing Address
First Line	:	1909 MALLORY LN STE 302
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2843
Country	:	US
Telephone Number	:	615-905-4994
Fax Number	:	615-224-6950

Provider Business Practice Location Address
First Line	:	1909 MALLORY LN STE 302
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37067-2843
Country	:	US
Telephone Number	:	615-905-4994
Fax Number	:	615-224-6950

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	12/28/2022

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1346059011 — VERSAL
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Directions to “ JILL C FICHTEL MD” Practice Location

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