Healthcare Provider Details

I. General information

NPI: 1487622452
Provider Name (Legal Business Name): JACK TARLETON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267 MCDOWELL ST FULLERTON GENETICS LABORATORY
ASHEVILLE NC
28803-2606
US

IV. Provider business mailing address

54 ARCO RD
ASHEVILLE NC
28805-1921
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-1015
  • Fax:
Mailing address:
  • Phone: 828-298-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: