Provider Demographics
NPI:1073715645
Name:PICKELL, JULIE D
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:PICKELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 HUNTER CREST DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6508
Mailing Address - Country:US
Mailing Address - Phone:423-718-2387
Mailing Address - Fax:
Practice Address - Street 1:9413 APISON PIKE STE 108
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-5628
Practice Address - Country:US
Practice Address - Phone:423-396-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist