Individual
JILL W WIREMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
151 LAKE HARBOR DR, GRAY, TN 37615-2972
(423) 956-3187
Mailing address
151 LAKE HARBOR DR, GRAY, TN 37615-2972
(423) 956-3187
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
24447
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3076811
—
TN
Enumeration date
06/15/2005
Last updated
08/07/2023
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