Individual
JIMMIE MANCELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1265 UNION AVE, MEMPHIS, TN 38104-3415
(901) 516-2362
(901) 844-1439
Mailing address
PO BOX 1000, DEPT 267, MEMPHIS, TN 38148-0267
(901) 516-2362
(901) 844-1439
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
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