Provider Demographics
NPI:1316001282
Name:AYERS, JACQUELINE LOU (DPH, CGP)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LOU
Last Name:AYERS
Suffix:
Gender:F
Credentials:DPH, CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12215 MOSSY POINT WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-0610
Mailing Address - Country:US
Mailing Address - Phone:865-250-9326
Mailing Address - Fax:865-531-8990
Practice Address - Street 1:9000 EXECUTIVE PARK DR
Practice Address - Street 2:SUITE A-204
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4685
Practice Address - Country:US
Practice Address - Phone:865-531-0008
Practice Address - Fax:865-531-8990
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41391835G0303X
GARPH0163821835G0303X
VA02020130441835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric