Individual
BROUGHTON D JOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
135 W RAVINE RD, SUITE 5-B, KINGSPORT, TN 37660-3847
(423) 224-3460
(423) 224-3465
Mailing address
PO BOX 535744, ATLANTA, GA 30353-5510
(844) 294-5114
(865) 691-0843
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
21958
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00013859
NHC CARE ADMINISTRATORS
—
01
—
050043321
RAILROAD MEDICARE
—
01
—
240137
ANTHEM BCBS
—
01
—
3045725
BLUE SHIELD OF TN
—
05
—
3082522
—
TN
05
—
5704791
—
VA
01
—
TN0100
JOHN DEERE
—
Enumeration date
08/09/2005
Last updated
04/12/2017
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