Healthcare Provider Details

I. General information

NPI: 1770187734
Provider Name (Legal Business Name): JACKSON ANESTHESIOLOGY GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 TUCKER ST STE 2
JACKSON TN
38301-4055
US

IV. Provider business mailing address

PO BOX 3572
JACKSON TN
38303-3572
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-1853
  • Fax: 731-664-7731
Mailing address:
  • Phone: 731-668-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL RYAN THROWER
Title or Position: PARTNER
Credential: MD
Phone: 731-668-1853