Provider Demographics
NPI:1053489187
Name:JETER, JULIE W (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:W
Last Name:JETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 ALCOA HWY # U67
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:865-305-9350
Mailing Address - Fax:865-305-8681
Practice Address - Street 1:1924 ALCOA HWY # U67
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-305-9350
Practice Address - Fax:865-305-8681
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29613207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1689631137OtherGROUP NPI
3373352OtherMEDICARE GROUP
TN1510993Medicaid
TN3373352OtherMEDICAID GROUP
TN3821094Medicare PIN
3373352OtherMEDICARE GROUP
TN1510993Medicaid
TN38210931Medicare PIN