Provider Demographics
NPI:1487071171
Name:JWSCHEPERSMD
Entity type:Organization
Organization Name:JWSCHEPERSMD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WISDOM-SCHEPERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-930-8390
Mailing Address - Street 1:207 N BOONE ST
Mailing Address - Street 2:SUITE 28
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5675
Mailing Address - Country:US
Mailing Address - Phone:423-930-8390
Mailing Address - Fax:888-965-5582
Practice Address - Street 1:207 N BOONE ST
Practice Address - Street 2:SUITE 28
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5675
Practice Address - Country:US
Practice Address - Phone:423-930-8390
Practice Address - Fax:888-965-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-20
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN393252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30006764OtherMEDICARE PTAN