Healthcare Provider Details

I. General information

NPI: 1407850001
Provider Name (Legal Business Name): JASON JAMES EVERLY PHARM.D., R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 PARKWOOD CIRCLE SE SUITE 325 ECG, LLC,,
ATLANTA GA
30339
US

IV. Provider business mailing address

8020 VEGAS CIR
WEST CHESTER OH
45069-9290
US

V. Phone/Fax

Practice location:
  • Phone: 513-846-7283
  • Fax:
Mailing address:
  • Phone: 513-860-0407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH021809
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03325555
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: