MEDICARE: JESSICA ASHLEE MCCALL DO

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	4826	TN

General Provider Information

NPI Number	:	1659831592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA ASHLEE MCCALL DO

Provider Business Mailing Address
First Line	:	3562 MIMOSA AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38111-6112
Country	:	US
Telephone Number	:	580-475-4101
Fax Number	:

Provider Business Practice Location Address
First Line	:	920 MADISON AVE SUITE 447
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38163-3438
Country	:	US
Telephone Number	:	901-287-6756
Fax Number	:

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

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	04/03/2023

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