Provider Demographics
NPI:1518460500
Name:DR. TESA H. JOLLY
Entity Type:Organization
Organization Name:DR. TESA H. JOLLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-363-1564
Mailing Address - Street 1:217 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-2812
Mailing Address - Country:US
Mailing Address - Phone:931-363-1564
Mailing Address - Fax:931-363-1559
Practice Address - Street 1:217 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-2812
Practice Address - Country:US
Practice Address - Phone:931-363-1564
Practice Address - Fax:931-363-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN89411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty