Provider Demographics
NPI:1912092024
Name:IVINS, JEFFREY JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOSEPH
Last Name:IVINS
Suffix:
Gender:M
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 110
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3486
Mailing Address - Country:US
Mailing Address - Phone:423-746-0122
Mailing Address - Fax:423-745-9456
Practice Address - Street 1:711 COOK DR
Practice Address - Street 2:SUITE 110
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-3486
Practice Address - Country:US
Practice Address - Phone:423-746-0122
Practice Address - Fax:423-745-9456
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055766207R00000X
TN14733207R00000X
TNMD14733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510664Medicaid
TN1510664Medicaid