Provider Demographics
NPI:1467613430
Name:MCCALL, JENNA KATHLEEN NEIL (MD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:KATHLEEN NEIL
Last Name:MCCALL
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:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:414 GREENBELT DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5702
Practice Address - Country:US
Practice Address - Phone:865-982-0032
Practice Address - Fax:866-307-8963
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN59798208000000X, 208000000X
SCLL30987208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ051936Medicaid