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NPI Code Detail

MEDICARE: DR. SANJIVINI VISHWAS JACOB M. D.

MEDICARE: DR. SANJIVINI VISHWAS JACOB M. D.
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
12083A0300XAddiction Medicine (Preventive Medicine) Physician044848TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629234521
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANJIVINI VISHWAS JACOB M. D.
Provider Business Mailing Address
First Line : 6141 SHALLOWFORD RD STE 100
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-1663
Country : US
Telephone Number : 423-498-2000
Fax Number : 423-498-2001
Provider Business Practice Location Address
First Line : 6141 SHALLOWFORD RD STE 100
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-1663
Country : US
Telephone Number : 423-498-2000
Fax Number : 423-498-2001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2008
Last Update Date : 02/23/2026

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