Provider Demographics
NPI:1679056485
Name:TWIGG, JAY
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:TWIGG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 BROOKLAWN ST
Mailing Address - Street 2:
Mailing Address - City:FARRAGUT
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2875
Mailing Address - Country:US
Mailing Address - Phone:865-671-7920
Mailing Address - Fax:865-671-7925
Practice Address - Street 1:189 BROOKLAWN ST
Practice Address - Street 2:
Practice Address - City:FARRAGUT
Practice Address - State:TN
Practice Address - Zip Code:37934-2875
Practice Address - Country:US
Practice Address - Phone:865-671-7920
Practice Address - Fax:865-671-7925
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator