Provider Demographics
NPI:1952646176
Name:JACOBS, HARVEY A (MD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:A
Last Name:JACOBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:608 SWANSONS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4500
Mailing Address - Country:US
Mailing Address - Phone:423-855-5655
Mailing Address - Fax:423-899-9330
Practice Address - Street 1:608 SWANSONS RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4500
Practice Address - Country:US
Practice Address - Phone:423-855-5655
Practice Address - Fax:423-899-9330
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000021589207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3870460OtherPHYSICIAN SUPPLIES
TNA01564Medicare UPIN