Provider Demographics
NPI:1194775155
Name:JACQUES, JULIE A (DO)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:JACQUES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 W MORRIS BLVD
Mailing Address - Street 2:HEALTHSTAR PHYSICIANS STE G
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813
Mailing Address - Country:US
Mailing Address - Phone:423-318-0014
Mailing Address - Fax:423-318-2595
Practice Address - Street 1:1907 W MORRIS BLVD
Practice Address - Street 2:HEALTHSTAR PHYSICIANS STE G
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37813
Practice Address - Country:US
Practice Address - Phone:423-318-0014
Practice Address - Fax:423-318-2595
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO14972084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3307672Medicaid
TN3307672Medicaid
TN3307672Medicare PIN