Healthcare Provider Details

I. General information

NPI: 1467816652
Provider Name (Legal Business Name): JONATHAN JACOB ALLRED
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ALCOA HWY U.T. MEDICAL CENTER
KNOXVILLE TN
37920
US

IV. Provider business mailing address

PO BOX 1168
JAMESTOWN TN
38556-1168
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-9340
  • Fax:
Mailing address:
  • Phone: 423-444-9584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036155048
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2021001554
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number57895
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: