Provider Demographics
NPI:1992090153
Name:JATTA, PA M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:PA
Middle Name:M
Last Name:JATTA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 CRYSTAL SPRING LN
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-4114
Mailing Address - Country:US
Mailing Address - Phone:859-625-4096
Mailing Address - Fax:
Practice Address - Street 1:2615 FRANKLIN PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3007
Practice Address - Country:US
Practice Address - Phone:615-298-4806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN343941835P1200X
KY0150611835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy