Provider Demographics
NPI:1487637864
Name:JENNINGS, DAVID K (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:K
Last Name:JENNINGS
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:PO BOX 41527
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38174-1527
Mailing Address - Country:US
Mailing Address - Phone:901-272-0003
Mailing Address - Fax:901-272-7179
Practice Address - Street 1:1200 PEABODY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4506
Practice Address - Country:US
Practice Address - Phone:901-272-0003
Practice Address - Fax:901-272-7179
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN000000020615OtherTENNCARE TLC
TN4025609OtherBLUE CROSS
TN3388963Medicaid
TN3388963Medicaid
TN3002683Medicare ID - Type Unspecified
TN4025609OtherBLUE CROSS