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NPI Code Detail

MEDICARE: DR. PA M JATTA PHARMD

MEDICARE: DR. PA M JATTA PHARMD
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
11835P1200XPharmacotherapy Pharmacist34394TN
21835P1200XPharmacotherapy Pharmacist015061KY

General Provider Information

NPI Number : 1992090153
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PA M JATTA PHARMD
Provider Business Mailing Address
First Line : 2720 CRYSTAL SPRING LN
Second Line :
City : HERMITAGE
State : TN
Zip : 37076-4114
Country : US
Telephone Number : 859-625-4096
Fax Number :
Provider Business Practice Location Address
First Line : 2615 FRANKLIN PIKE
Second Line :
City : NASHVILLE
State : TN
Zip : 37204-3007
Country : US
Telephone Number : 615-298-4806
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2011
Last Update Date : 06/16/2011

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