Provider Demographics
NPI:1205814605
Name:MEJIA, ERNESTO (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:
Last Name:MEJIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MCFARLAND ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814
Mailing Address - Country:US
Mailing Address - Phone:423-587-0740
Mailing Address - Fax:423-581-0063
Practice Address - Street 1:500 MCFARLAND ST
Practice Address - Street 2:SUITE B
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814
Practice Address - Country:US
Practice Address - Phone:423-587-0740
Practice Address - Fax:423-581-0063
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25075207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3083165Medicare ID - Type Unspecified
F84768Medicare UPIN