Basic Information
| Provider Information | |||||||||
| NPI: | 1053498311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JACK | ||||||||
| FirstName: | MEG | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3607 LEGACY DR | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371726381 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153822026 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1313 21ST AVE S | ||||||||
| Address2: | 703 OXFORD HOUSE | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372320001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6159360087 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 41400 | TN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.