Jacobs, Gordon Jackson

Jacobs, Gordon Jackson is an individual health care provider with primary practice located at 485 N Chancery St , Mc Minnville TN 37110-2049. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Jacobs, Gordon Jackson can be contacted via phone (931) 507-5000.

Contact Information

Primary practice address
485 N Chancery St Mc Minnville TN 37110-2049
Phone: (931) 507-5000
Fax: (931) 507-5550
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD010995 Tennessee

Profile Details

NPI number 1932172624
LBN Legal business name Jacobs, Gordon Jackson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 11th, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932172624 NPPES
Tennessee MEDICAID 3164944

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