Provider Demographics
NPI:1952328874
Name:MUNSON-JACKSON, JULIE C (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:C
Last Name:MUNSON-JACKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 MOUNTAIN VIEW ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6685
Mailing Address - Country:US
Mailing Address - Phone:423-495-5951
Mailing Address - Fax:423-495-5999
Practice Address - Street 1:6401 MOUNTAIN VIEW ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6685
Practice Address - Country:US
Practice Address - Phone:423-495-5951
Practice Address - Fax:423-495-5999
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000039783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN03-0600637OtherTAX ID