Basic Information
| Provider Information | |||||||||
| NPI: | 1831449800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JUBRAN | ||||||||
| FirstName: | CALLIE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RD LDN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCCAMY | ||||||||
| OtherFirstName: | CALLIE | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RD LDN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2100 W CLINCH AVE | ||||||||
| Address2: | #510 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379162219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655463998 | ||||||||
| FaxNumber: | 8655461123 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 W CLINCH AVE | ||||||||
| Address2: | #510 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379162219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655463998 | ||||||||
| FaxNumber: | 8655461123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2012 | ||||||||
| LastUpdateDate: | 01/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | CDR01047420 | TN | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.