Healthcare Provider Details

I. General information

NPI: 1790847036
Provider Name (Legal Business Name): JASON D GOINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 N PETERS RD SUITE 203
KNOXVILLE TN
37923-4933
US

IV. Provider business mailing address

244 N PETERS RD SUITE 203
KNOXVILLE TN
37923-4933
US

V. Phone/Fax

Practice location:
  • Phone: 865-694-6132
  • Fax: 865-694-6143
Mailing address:
  • Phone: 865-694-6132
  • Fax: 865-694-6143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number5201
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: