Individual
JACOB FUQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
961 OAK RIDGE TPKE, OAK RIDGE, TN 37830-8832
(865) 375-8910
(865) 483-3807
Mailing address
PO BOX 306556, NASHVILLE, TN 37230-6556
(865) 694-0062
(865) 694-7907
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
6571
TN
Other
Enumeration date
06/02/2025
Last updated
06/02/2025
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