1962651521 NPI number — DR. VIJAYA LAKSHMI JALEEL

Table of content: DR. VIJAYA LAKSHMI JALEEL (NPI 1962651521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962651521 NPI number — DR. VIJAYA LAKSHMI JALEEL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JALEEL
Provider First Name:
VIJAYA
Provider Middle Name:
LAKSHMI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAMMILI
Provider Other First Name:
VIJAYA
Provider Other Middle Name:
LAKSHMI
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962651521
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2929 OLD FRANKLIN RD
Provider Second Line Business Mailing Address:
APT. # 920
Provider Business Mailing Address City Name:
ANTIOCH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37013-3198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-422-2753
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 DR. D.B. TODD JR. BLVD.
Provider Second Line Business Practice Location Address:
ELAM CENTER
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-327-6350
Provider Business Practice Location Address Fax Number:
615-327-6260
Provider Enumeration Date:
09/18/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  607 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)