NPIMap

Individual provider Active NPI

Jacob Allen Jolly

  • Pharmacist
  • Brentwood, TN
National Provider Identifier
1134466089
Registry record updated Jan 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
34340 Issued in TN
Practice address
10638 Concord Rd
Brentwood, TN 37027-8811
Phone
(615) 941-8879
NPI assigned
Jan 12, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 34340 TN Primary

Addresses

Primary practice location

10638 Concord Rd
Brentwood, TN 37027-8811

Mailing address

10638 Concord Rd
Brentwood, TN 37027-8811
Phone (615) 941-8879

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
34340TNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Publix Tennessee, LLC Past Accepting new patients
Publix Tennessee LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357948800000",
    "number": "1134466089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10638 CONCORD RD",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370278811",
            "telephone_number": "615-941-8879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10638 CONCORD RD",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370278811",
            "telephone_number": "615-941-8879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOLLY",
        "first_name": "JACOB",
        "middle_name": "ALLEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-12",
        "last_updated": "2013-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TN",
            "license": "34340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brentwood, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.