Provider Demographics
NPI:1043888118
Name:JERNIGAN, JOSHUA CHRISTOPHER (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:CHRISTOPHER
Last Name:JERNIGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 ELAINE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-3600
Mailing Address - Country:US
Mailing Address - Phone:678-899-0651
Mailing Address - Fax:
Practice Address - Street 1:495 DUNLOP LN STE 112
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5296
Practice Address - Country:US
Practice Address - Phone:931-221-0050
Practice Address - Fax:931-221-0052
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1223091223G0001X
TN126401223X0400X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice