Provider Demographics
NPI:1356367452
Name:HAMPTON, JACQUELINE L (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:L
Last Name:HAMPTON
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 1:5131 QUINCE RD STE 3D
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-6846
Mailing Address - Country:US
Mailing Address - Phone:901-701-1888
Mailing Address - Fax:901-701-1136
Practice Address - Street 1:5131 QUINCE RD STE 3D
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-6846
Practice Address - Country:US
Practice Address - Phone:901-701-1888
Practice Address - Fax:901-701-1136
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15315207R00000X
TN27307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL730-19442OtherBCBS AL
MS00118244Medicaid
G16648Medicare UPIN
103I110980Medicare PIN
AL730-19442OtherBCBS AL