Provider Demographics
NPI:1386827236
Name:JAIN, PRATHMESH (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATHMESH
Middle Name:
Last Name:JAIN
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 1:569 SKYLINE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3911
Mailing Address - Country:US
Mailing Address - Phone:731-427-7888
Mailing Address - Fax:731-265-4168
Practice Address - Street 1:569 SKYLINE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3911
Practice Address - Country:US
Practice Address - Phone:731-427-7888
Practice Address - Fax:731-265-4168
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN618174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709355Medicaid
TN1141740001Medicare NSC
TN3001074Medicare PIN
TNP00603049Medicare PIN