MEDICARE: CAMERON JEDIDIAH HIGGINS PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1841004520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMERON JEDIDIAH HIGGINS PA

Provider Business Mailing Address
First Line	:	PO BOX 850
Second Line	:
City	:	ROGERSVILLE
State	:	TN
Zip	:	37857-0850
Country	:	US
Telephone Number	:	423-272-9163
Fax Number	:	423-921-6920

Provider Business Practice Location Address
First Line	:	580 VAN HILL RD
Second Line	:
City	:	GREENEVILLE
State	:	TN
Zip	:	37745-7608
Country	:	US
Telephone Number	:	423-234-1020
Fax Number	:	423-234-0646

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

Provider Enumeration Date	:	02/04/2025
Last Update Date	:	02/04/2025

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