Healthcare Provider Details

I. General information

NPI: 1174003800
Provider Name (Legal Business Name): JASON O'CONNER MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 13TH AVE SE
DECATUR AL
35601
US

IV. Provider business mailing address

1316 SOMERVILLE RD SE STE 1
DECATUR AL
35601-4309
US

V. Phone/Fax

Practice location:
  • Phone: 256-260-7306
  • Fax: 256-355-6092
Mailing address:
  • Phone: 256-260-7361
  • Fax: 256-355-6092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: