Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 0101241983 | VA |
Y | 207V00000X | Obstetrician & Gynecologist | MD40762 | TN |
N | 207V00000X | Obstetrician & Gynecologist | ME91543 | FL |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD40762 | TN |
NPI | 1407834211 |
---|---|
Provider Name | Dr. Chadi Milad Jarjoura |
First Address | Kingsport, TN 37660-3805 |
Second Address | Kingsport, TN 37660-3805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2006 |
Last Update Date | 30/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G62075 | (02) | |
PENDING | (05) | TN |