Provider Demographics
NPI:1659564474
Name:MIRZA, JENNIFER AYERS (DO)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:AYERS
Last Name:MIRZA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2205 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3230
Mailing Address - Country:US
Mailing Address - Phone:423-508-6733
Mailing Address - Fax:423-508-6744
Practice Address - Street 1:2205 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3230
Practice Address - Country:US
Practice Address - Phone:423-508-6733
Practice Address - Fax:423-508-6744
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA116018700207R00000X
TNDO00000002410207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine