MEDICARE: JONATHAN WILLIAM HAFNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	53596	TN

General Provider Information

NPI Number	:	1811165608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN WILLIAM HAFNER M.D.

Provider Business Mailing Address
First Line	:	DEPT 8888620
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37995-0001
Country	:	US
Telephone Number	:	865-670-6199
Fax Number	:	865-670-6198

Provider Business Practice Location Address
First Line	:	49 CLEVELAND ST STE 220
Second Line	:
City	:	CROSSVILLE
State	:	TN
Zip	:	38555-2854
Country	:	US
Telephone Number	:	931-219-9990
Fax Number	:	931-717-1180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/20/2024

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