Healthcare Provider Details

I. General information

NPI: 1619201274
Provider Name (Legal Business Name): JERRY DAVID HINTON LPO, LPED, BOCPO, CO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 S CUMBERLAND ST
MORRISTOWN TN
37813-5235
US

IV. Provider business mailing address

1044 S CUMBERLAND ST
MORRISTOWN TN
37813-5235
US

V. Phone/Fax

Practice location:
  • Phone: 423-318-8824
  • Fax: 423-318-2872
Mailing address:
  • Phone: 423-318-8824
  • Fax: 423-318-2872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberORT0000000138
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPRO0000000072
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: