Provider Demographics
NPI:1821028788
Name:GUMNICK, JANE F (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:F
Last Name:GUMNICK
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:PO BOX 8265
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-8265
Mailing Address - Country:US
Mailing Address - Phone:678-984-3668
Mailing Address - Fax:
Practice Address - Street 1:119 S MOORE RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-4806
Practice Address - Country:US
Practice Address - Phone:678-984-3668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN354342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3282227OtherMEDICARE PART B
TN444002Medicare ID - Type Unspecified
TNH77140Medicare UPIN