Provider Demographics
NPI:1851901375
Name:PLATT, JAMIE (PHD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:PLATT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 LOUDON VIEW LN
Mailing Address - Street 2:
Mailing Address - City:FRIENDSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37737-2301
Mailing Address - Country:US
Mailing Address - Phone:949-244-2591
Mailing Address - Fax:
Practice Address - Street 1:725 LOUDON VIEW LN
Practice Address - Street 2:
Practice Address - City:FRIENDSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37737-2301
Practice Address - Country:US
Practice Address - Phone:949-244-2591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory