Provider Demographics
NPI:1578789905
Name:DIGGS, JACQULYN MAYRE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQULYN
Middle Name:MAYRE
Last Name:DIGGS
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 1:4136 MOUNTAIN VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-2034
Mailing Address - Country:US
Mailing Address - Phone:423-876-0725
Mailing Address - Fax:
Practice Address - Street 1:4136 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-2034
Practice Address - Country:US
Practice Address - Phone:423-876-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN00282672083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3839291Medicaid
TNC15263Medicare UPIN