Provider Demographics
NPI:1780648063
Name:JEWETT, MICHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:JEWETT
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:PO BOX 556
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-0556
Mailing Address - Country:US
Mailing Address - Phone:423-788-0123
Mailing Address - Fax:866-212-2654
Practice Address - Street 1:121 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1317
Practice Address - Country:US
Practice Address - Phone:423-788-0123
Practice Address - Fax:866-212-2654
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD37121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNTN01Q8OtherJOHN DEERE
TN3880278Medicaid
TN4054466OtherBCBS
TN4054466OtherBCBS
TNTN01Q8OtherJOHN DEERE