Healthcare Provider Details

I. General information

NPI: 1346860673
Provider Name (Legal Business Name): JARED ATCHISON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11012 E 13 MILE RD STE 112
WARREN MI
48093-2546
US

IV. Provider business mailing address

11012 E 13 MILE RD STE 112
WARREN MI
48093-2546
US

V. Phone/Fax

Practice location:
  • Phone: 586-578-9595
  • Fax: 586-573-2562
Mailing address:
  • Phone: 586-578-9595
  • Fax: 586-573-2562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: