Provider Demographics
NPI:1437204039
Name:BIVENS, JENNIFER M (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:BIVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2228 POPLAR GROVE DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4325
Mailing Address - Country:US
Mailing Address - Phone:423-396-3359
Mailing Address - Fax:423-648-6484
Practice Address - Street 1:7446 SHALLOWFORD RD
Practice Address - Street 2:STE 103
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-8815
Practice Address - Country:US
Practice Address - Phone:423-648-6483
Practice Address - Fax:423-648-6484
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN30498208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine