Provider Demographics
NPI:1194735738
Name:KELLUM, JESSE BLAKE JR (MD)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:BLAKE
Last Name:KELLUM
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1272 GARRISON DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2598
Mailing Address - Country:US
Mailing Address - Phone:615-867-8090
Mailing Address - Fax:675-867-8093
Practice Address - Street 1:1272 GARRISON DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2598
Practice Address - Country:US
Practice Address - Phone:615-867-8090
Practice Address - Fax:675-867-8093
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2020-06-26
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Provider Licenses
StateLicense IDTaxonomies
TN514652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology