Provider Demographics
NPI:1467594184
Name:JAIN, ANGELI (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELI
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 US HIGHWAY 51 BYP E
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-2127
Mailing Address - Country:US
Mailing Address - Phone:731-286-1900
Mailing Address - Fax:731-286-1939
Practice Address - Street 1:1445 US HIGHWAY 51 BYP E
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-2127
Practice Address - Country:US
Practice Address - Phone:731-286-1900
Practice Address - Fax:731-286-1939
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine