Provider Demographics
NPI:1750593208
Name:EARLY, JACQUELYN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:ANN
Last Name:EARLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16000 JOHNSTON MEMORIAL DR
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-7659
Mailing Address - Country:US
Mailing Address - Phone:276-258-1100
Mailing Address - Fax:276-258-1125
Practice Address - Street 1:16000 JOHNSTON MEMORIAL DR
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24211-7659
Practice Address - Country:US
Practice Address - Phone:276-258-1100
Practice Address - Fax:276-258-1125
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2007-00248207P00000X
VA0101247123207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1750593208Medicaid
VA1750593208Medicaid