Basic Information
| Provider Information | |||||||||
| NPI: | 1962651521 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JALEEL | ||||||||
| FirstName: | VIJAYA | ||||||||
| MiddleName: | LAKSHMI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KAMMILI | ||||||||
| OtherFirstName: | VIJAYA | ||||||||
| OtherMiddleName: | LAKSHMI | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2929 OLD FRANKLIN RD | ||||||||
| Address2: | APT. # 920 | ||||||||
| City: | ANTIOCH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370133198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064222753 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1005 DR. D.B. TODD JR. BLVD. | ||||||||
| Address2: | ELAM CENTER | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153276350 | ||||||||
| FaxNumber: | 6153276260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2008 | ||||||||
| LastUpdateDate: | 09/18/2008 | ||||||||
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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 | 2084P0800X | 607 | TN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.