Individual provider · NPI-1

Dr. Jesse Blake Kellum Jr., M.D.

Psychiatry & Neurology, Neurology · Murfreesboro, TN

NPI number1194735738
StatusActive
Last updated in NPPESJun 26, 2020

Details

NPI
1194735738
Entity type
Individual (NPI-1)
Name
Dr. Jesse Blake Kellum Jr.
Credential
M.D.
Sex
Male
Sole proprietor
No
Enumeration date
Aug 8, 2006
Certification date
Jun 26, 2020
Last updated
Jun 26, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2084N0400X Psychiatry & Neurology, Neurology51465TNYes

Practice location

1272 Garrison Dr
Murfreesboro, TN 37129-2598

Phone 615-867-8090 · Fax 675-867-8093

Mailing address

1272 Garrison Dr
Murfreesboro, TN 37129-2598

Phone 615-867-8090 · Fax 675-867-8093

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