Provider Demographics
NPI:1053555433
Name:JAIN, PRIYA NARAYANAN (MD)
Entity type:Individual
Prefix:MRS
First Name:PRIYA
Middle Name:NARAYANAN
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:PRIYA
Other - Middle Name:
Other - Last Name:JAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:325 N. STATE OF FRANKLIN ROAD
Practice Address - Street 2:GROUND FL
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604
Practice Address - Country:US
Practice Address - Phone:423-439-7320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-29
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA126025208000000X
NY283696208000000X
TN62574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ066396Medicaid