Organization
JABBOK TREATMENT CENTER, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELINE D IRWIN (OWNER/COO)
77316167753
Entity
Organization
Contact information
Practice address
40 IRWIN ST, SAVANNAH, TN 38372-3084
(731) 727-5603
(731) 925-2114
Mailing address
40 IRWIN ST, SAVANNAH, TN 38372-3084
(731) 727-5603
(731) 925-2114
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
207QA0401X
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02000211
—
TN
05
—
1521170
—
TN
Enumeration date
06/08/2016
Last updated
06/08/2016
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