Provider Demographics
NPI:1659822492
Name:SOUTHERLAND, JAMEY
Entity Type:Individual
Prefix:
First Name:JAMEY
Middle Name:
Last Name:SOUTHERLAND
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 1:471 TYLER DR
Mailing Address - Street 2:
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725-6358
Mailing Address - Country:US
Mailing Address - Phone:865-888-9206
Mailing Address - Fax:865-375-5030
Practice Address - Street 1:471 TYLER DR
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-6358
Practice Address - Country:US
Practice Address - Phone:865-888-9206
Practice Address - Fax:865-375-5030
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)