Provider Demographics
NPI:1558310177
Name:SCANLAND, JEANNE ANDREE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:ANDREE
Last Name:SCANLAND
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 1:6500 QUEENSBURY LN.
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343
Mailing Address - Country:US
Mailing Address - Phone:423-667-1312
Mailing Address - Fax:423-698-1926
Practice Address - Street 1:6500 QUEENSBURY LN.
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:423-667-1312
Practice Address - Fax:423-698-1926
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD173972086S0122X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3022091OtherBCBST
TN3022091OtherBCBST
TN3059843Medicare ID - Type Unspecified