Healthcare Provider Details

I. General information

NPI: 1487559597
Provider Name (Legal Business Name): JONATHAN P ANDERSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 ERWIN HILLS RD
ASHEVILLE NC
28806-2185
US

IV. Provider business mailing address

341 TAVERNIER LN
CANDLER NC
28715-0718
US

V. Phone/Fax

Practice location:
  • Phone: 828-782-0048
  • Fax:
Mailing address:
  • Phone: 828-808-3160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP074803
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: