Provider Demographics
NPI:1417080847
Name:THREADGILL, JAIME SUE (DPH)
Entity Type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:SUE
Last Name:THREADGILL
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 DUGDALE ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3620
Mailing Address - Country:US
Mailing Address - Phone:423-752-8418
Mailing Address - Fax:
Practice Address - Street 1:110 N MARKET ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3905
Practice Address - Country:US
Practice Address - Phone:423-752-8104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5923183500000X, 1835G0303X, 1835N1003X, 1835P1200X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered1835P1300XPharmacy Service ProvidersPharmacistPsychiatric