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General NPI Number Information
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NPI Number | 1114167400
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Entity Type | Individual
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Provider Name | JASON AULTMAN RT(R)
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Gender | Male
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Dates
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Enumeration Date | 02/25/2009
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 1310 24TH AVE S
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City | NASHVILLE
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State | TN
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Zip | 37212-2637
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Country | US
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Telephone | 615-327-5339
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Fax |
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Provider Business Mailing Address
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Address Line | 306 STAFFORD CT
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City | SMYRNA
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State | TN
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Zip | 37167-9334
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Country | US
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Telephone | 615-424-2005
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number | 449592
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License Number State | TN
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