Provider Demographics
NPI:1144603192
Name:IGIETSEME, JOJACKSON (MS)
Entity Type:Individual
Prefix:
First Name:JOJACKSON
Middle Name:
Last Name:IGIETSEME
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5106 DELAWARE AVE
Mailing Address - Street 2:APT. 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-2173
Mailing Address - Country:US
Mailing Address - Phone:404-695-2343
Mailing Address - Fax:
Practice Address - Street 1:1500 21ST AVE S
Practice Address - Street 2:SUIE 2200
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3160
Practice Address - Country:US
Practice Address - Phone:615-936-4007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health