Provider Demographics
NPI:1306950126
Name:JAIN, PRADUMNA S (MD)
Entity type:Individual
Prefix:DR
First Name:PRADUMNA
Middle Name:S
Last Name:JAIN
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 1:9111 CROSS PARK DR STE D200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4521
Mailing Address - Country:US
Mailing Address - Phone:865-470-4130
Mailing Address - Fax:865-694-1655
Practice Address - Street 1:9111 CROSS PARK DR STE D200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4521
Practice Address - Country:US
Practice Address - Phone:865-470-4130
Practice Address - Fax:865-694-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000266672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3112481OtherBLUECROSS BLUE SHIELD
TN257338000OtherMAGELLAN
TN3095083Medicaid
TN257338000OtherMAGELLAN
TNG12388Medicare UPIN