Provider Demographics
NPI:1427184696
Name:EMBRY, JERRY JAGGERS (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:JAGGERS
Last Name:EMBRY
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 1:7632 GLEASON DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-6818
Mailing Address - Country:US
Mailing Address - Phone:865-470-2719
Mailing Address - Fax:865-694-4784
Practice Address - Street 1:7632 GLEASON DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-6818
Practice Address - Country:US
Practice Address - Phone:865-470-2719
Practice Address - Fax:865-694-4784
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000060802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NN0066727OtherUNITED BEHAVIORAL HEALTH
3305434OtherAETNA PROVIDER NUMBER
NN0066727OtherPIN #
TN3145120Medicaid
TN2004724OtherBCBS OF TENN. PIN #
TN3145120Medicaid
NN0066727OtherPIN #