Provider Demographics
NPI:1821130691
Name:ATKINS, JEFFERY VAUGHAN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:VAUGHAN
Last Name:ATKINS
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 1:3120 WATERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-1535
Mailing Address - Country:US
Mailing Address - Phone:423-821-0018
Mailing Address - Fax:
Practice Address - Street 1:ERLANGER BLEDSOE COUNTY HOSPITAL
Practice Address - Street 2:128 WHEELER ROAD
Practice Address - City:PIKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37367
Practice Address - Country:US
Practice Address - Phone:423-447-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000014114207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B59541Medicare UPIN