Provider Demographics
NPI:1972584571
Name:MANCELL, JIMMIE (MD)
Entity type:Individual
Prefix:
First Name:JIMMIE
Middle Name:
Last Name:MANCELL
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:PO BOX 1000
Mailing Address - Street 2:DEPT 267
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0267
Mailing Address - Country:US
Mailing Address - Phone:901-516-2362
Mailing Address - Fax:901-844-1439
Practice Address - Street 1:1265 UNION AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3415
Practice Address - Country:US
Practice Address - Phone:901-516-2362
Practice Address - Fax:901-844-1439
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27637208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN03097716Medicaid
TN4104674OtherBLUE CROSS TN
TN4104674OtherBLUE CROSS TN
G23496Medicare UPIN