Provider Demographics
NPI:1801107545
Name:GILBERT-GREEN, JACALYN PAIGE (DO)
Entity type:Individual
Prefix:
First Name:JACALYN
Middle Name:PAIGE
Last Name:GILBERT-GREEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:423-433-6200
Mailing Address - Fax:423-232-8567
Practice Address - Street 1:215 E WATAUGA AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4629
Practice Address - Country:US
Practice Address - Phone:423-433-6200
Practice Address - Fax:423-232-8567
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine