Provider Demographics
NPI:1598146607
Name:PUMILIA, JONATHAN NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:NICHOLAS
Last Name:PUMILIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:979 E 3RD ST STE B-601
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-778-8179
Mailing Address - Fax:423-778-8180
Practice Address - Street 1:979 E 3RD ST STE B-601
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-778-8179
Practice Address - Fax:423-778-8180
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58494208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN58494OtherMEDICAL LICENSE