Provider Demographics
NPI:1831449800
Name:JUBRAN, CALLIE M (RD LDN)
Entity type:Individual
Prefix:MS
First Name:CALLIE
Middle Name:M
Last Name:JUBRAN
Suffix:
Gender:F
Credentials:RD LDN
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:E
Other - Last Name:MCCAMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD LDN
Mailing Address - Street 1:2100 W CLINCH AVE
Mailing Address - Street 2:#510
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2219
Mailing Address - Country:US
Mailing Address - Phone:865-546-3998
Mailing Address - Fax:865-546-1123
Practice Address - Street 1:2100 W CLINCH AVE
Practice Address - Street 2:#510
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-2219
Practice Address - Country:US
Practice Address - Phone:865-546-3998
Practice Address - Fax:865-546-1123
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCDR01047420133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered