Provider Demographics
NPI:1417970054
Name:ROWLAND, JACK M (MD)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:M
Last Name:ROWLAND
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 1:1511 GUNBARREL RD STE 111
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-3897
Mailing Address - Country:US
Mailing Address - Phone:423-553-5999
Mailing Address - Fax:423-602-7456
Practice Address - Street 1:1511 GUNBARREL RD STE 111
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3897
Practice Address - Country:US
Practice Address - Phone:423-553-5999
Practice Address - Fax:423-602-7456
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34464207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA337633717AMedicaid
GA337633717AMedicaid
TN3854907Medicare PIN