Provider Demographics
NPI:1457363384
Name:BYRD, JENNY M (MD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:M
Last Name:BYRD
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 1:711 COOK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3486
Mailing Address - Country:US
Mailing Address - Phone:423-744-7585
Mailing Address - Fax:423-744-7075
Practice Address - Street 1:711 COOK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3486
Practice Address - Country:US
Practice Address - Phone:423-744-7585
Practice Address - Fax:423-744-7075
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD20239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3050659Medicaid
TN3050659Medicaid
TNE40676Medicare UPIN