Provider Demographics
NPI:1467458885
Name:YIUM, JACKSON J (MD)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:J
Last Name:YIUM
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 1:975 E 3RD ST
Mailing Address - Street 2:BOX 338
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2147
Mailing Address - Country:US
Mailing Address - Phone:423-648-9808
Mailing Address - Fax:423-648-4570
Practice Address - Street 1:960 E 3RD ST
Practice Address - Street 2:STE 208
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2104
Practice Address - Country:US
Practice Address - Phone:423-778-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8325207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3154099Medicaid
TN3154099Medicaid
B02501Medicare UPIN