Individual
THEOPHILUS JAMES HUMPHREYS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
164 W UNIVERSITY PKWY STE A, JACKSON, TN 38305-1621
(731) 215-1135
(731) 410-6156
Mailing address
127 STANWORTH GRV, JACKSON, TN 38305-4237
(731) 427-0322
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
5126
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1511064
—
TN
Enumeration date
12/23/2008
Last updated
05/18/2016
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