Provider Demographics
NPI:1548962228
Name:JAMISON, TAEISHA
Entity type:Individual
Prefix:
First Name:TAEISHA
Middle Name:
Last Name:JAMISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6716 WICKER AVE # 1
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-1410
Mailing Address - Country:US
Mailing Address - Phone:872-201-0720
Mailing Address - Fax:219-245-6841
Practice Address - Street 1:6716 WICKER AVE # 1
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323-1410
Practice Address - Country:US
Practice Address - Phone:872-201-0720
Practice Address - Fax:219-245-6841
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory