Provider Demographics
NPI:1093934341
Name:JACK, MEGAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:C
Last Name:JACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:C
Other - Last Name:HOAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9430 PARK WEST BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4204
Mailing Address - Country:US
Mailing Address - Phone:865-694-9886
Mailing Address - Fax:865-694-5023
Practice Address - Street 1:9430 PARK WEST BLVD STE 240
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4204
Practice Address - Country:US
Practice Address - Phone:865-694-9886
Practice Address - Fax:865-694-5023
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61315208200000X
FLME107194208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC45607UMedicare UPIN