Individual
JIMMIE MANCELL
Active
Individual
JIMMIE MANCELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27637
TN
208M00000X
Hospitalist Physician
27637
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03097716
—
TN
01
—
4104674
BLUE CROSS TN
TN
Enumeration date
11/10/2005
Last updated
10/18/2022
Update your record
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