Individual
JARED W PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2408 SUSANNAH ST STE 1, JOHNSON CITY, TN 37601-1765
(423) 434-6677
(423) 461-0000
Mailing address
2408 SUSANNAH ST STE 1, JOHNSON CITY, TN 37601-1765
(423) 434-6677
(423) 461-0000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2980
TN
208M00000X
Hospitalist Physician
2980
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396163101
—
VA
05
—
Q028929
—
TN
Enumeration date
03/31/2014
Last updated
12/30/2025
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