Provider Demographics
NPI:1265657951
Name:CAREY, JACK WILLARD III (MD)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:WILLARD
Last Name:CAREY
Suffix:III
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37074-1304
Mailing Address - Country:US
Mailing Address - Phone:615-374-2101
Mailing Address - Fax:
Practice Address - Street 1:220 BROADWAY
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37074-1304
Practice Address - Country:US
Practice Address - Phone:615-374-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45627208000000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100177760Medicaid
TN1523209Medicaid
TN4352344OtherBCBS
TN4352344OtherBCBS