Provider Demographics
NPI:1558596635
Name:ANDERSON, JAMIE CHARLES
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:CHARLES
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 LOUIS RHEA DR
Mailing Address - Street 2:
Mailing Address - City:SNEEDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37869-3022
Mailing Address - Country:US
Mailing Address - Phone:423-733-4950
Mailing Address - Fax:423-733-4952
Practice Address - Street 1:187 LOUIS RHEA DR
Practice Address - Street 2:
Practice Address - City:SNEEDVILLE
Practice Address - State:TN
Practice Address - Zip Code:37869-3022
Practice Address - Country:US
Practice Address - Phone:423-733-4950
Practice Address - Fax:423-733-4952
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000414172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver