Provider Demographics
NPI:1407834211
Name:JARJOURA, CHADI MILAD (MD)
Entity Type:Individual
Prefix:DR
First Name:CHADI
Middle Name:MILAD
Last Name:JARJOURA
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 1:105 W PARK DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3805
Mailing Address - Country:US
Mailing Address - Phone:423-224-3220
Mailing Address - Fax:423-224-3233
Practice Address - Street 1:105 W PARK DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3805
Practice Address - Country:US
Practice Address - Phone:423-224-3220
Practice Address - Fax:423-224-3233
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91543207V00000X
VA0101241983207V00000X
TNMD40762207VF0040X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGMedicaid
TNPENDINGMedicare ID - Type Unspecified
TNPENDINGMedicaid