Jabbok Treatment Center, LLC.

Primary specialty

Addiction Medicine (Family Medicine) PhysicianTaxonomy code 207QA0401X

License

207QA0401X Issued in TN

Legal business name

JABBOK TREATMENT CENTER, LLC.

Practice address

40 Irwin St
Savannah, TN 38372-3084

Phone

(731) 727-5603

Fax

(731) 925-2114

NPI assigned

Jun 8, 2016

Last updated

Jun 8, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jacqueline D Irwin

Title

Owner/Coo

Phone

77316167753

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1465344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465344000000",
    "number": "1740639962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 IRWIN ST",
            "city": "SAVANNAH",
            "state": "TN",
            "postal_code": "383723084",
            "telephone_number": "731-727-5603",
            "fax_number": "731-925-2114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 IRWIN ST",
            "city": "SAVANNAH",
            "state": "TN",
            "postal_code": "383723084",
            "telephone_number": "731-727-5603",
            "fax_number": "731-925-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JABBOK TREATMENT CENTER, LLC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-08",
        "last_updated": "2016-06-08",
        "status": "A",
        "authorized_official_last_name": "IRWIN",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/COO",
        "authorized_official_telephone_number": "77316167753"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "TN",
            "license": "207QA0401X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02000211",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1521170",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Darrin Hurst, D.P.M.
• Independent Physical Therapy LLC
• Samantha Jo Ivy, APRN
• J. Park & Son, Inc.
• Jabbok Health Center, LLC
• Melissa Jackson
• Rhonda Jaco, B.S.
• Abby Elizabeth Jerrolds, NP
• Jerry D Rogers
• John D. Lay MD

• Addiction Medicine (Family Medicine) Physician in Savannah, TN
• Providers in Savannah, TN by specialty
• Addiction Medicine (Family Medicine) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2016; 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.