Healthcare Provider Details

I. General information

NPI: 1144500554
Provider Name (Legal Business Name): JONATHAN JUSTIN HUTCHESON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 CONGRESS PARK DR
CENTERVILLE OH
45459
US

IV. Provider business mailing address

7700 WASHINGTON VILLAGE DR STE 260
CENTERVILLE OH
45459-4097
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-9013
  • Fax: 937-435-1458
Mailing address:
  • Phone: 937-435-9013
  • Fax: 937-435-1458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.012375
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: