Individual
BRADLEY PETERSON JAQUITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1819 CLINCH AVE STE 100, KNOXVILLE, TN 37916-2435
(865) 524-5365
(865) 524-5047
Mailing address
PO BOX 306556, NASHVILLE, TN 37230-6556
(865) 694-0062
(865) 694-7907
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
54212
TN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
54212
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q024105
—
TN
Enumeration date
03/26/2011
Last updated
07/11/2025
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