Provider Demographics
NPI:1639246739
Name:OWENS, JEREMY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WAYNE
Last Name:OWENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2230 COWAN HWY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-2627
Mailing Address - Country:US
Mailing Address - Phone:931-962-3500
Mailing Address - Fax:
Practice Address - Street 1:4502 VEGA ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5305
Practice Address - Country:US
Practice Address - Phone:228-696-9224
Practice Address - Fax:228-696-9228
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS203542084P0800X
TN427552084P0800X
KY405122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry