Provider Demographics
NPI:1598146607
Name:PUMILIA, JONATHAN NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:NICHOLAS
Last Name:PUMILIA
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 1:960 E 3RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2134
Mailing Address - Country:US
Mailing Address - Phone:423-778-2998
Mailing Address - Fax:423-778-2611
Practice Address - Street 1:960 E 3RD ST STE 200
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-2998
Practice Address - Fax:423-778-2611
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58494207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN58494OtherMEDICAL LICENSE