Provider Demographics
NPI:1013303031
Name:JAMISON, ABBEY MARIE (LCGC)
Entity Type:Individual
Prefix:
First Name:ABBEY
Middle Name:MARIE
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LCGC
Other - Prefix:
Other - First Name:ABBEY
Other - Middle Name:MARIE
Other - Last Name:BAMFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:2018 CLINCH AVE
Practice Address - Street 2:2ND FLOOR SOUTH TOWER
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2301
Practice Address - Country:US
Practice Address - Phone:865-525-1425
Practice Address - Fax:877-935-4221
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ022568Medicaid