Individual
MRS. JAMIE L BACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 956-0088
Mailing address
3701 REDDICK RD, PALMYRA, TN 37142-2127
(931) 624-9695
Taxonomy
Speciality
Code
Description
License number
State
246ZE0500X
EEG Specialist/Technologist
Primary
8325
TN
Other
Enumeration date
04/08/2009
Last updated
04/08/2009
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