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General NPI Number Information
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NPI Number | 1184277022
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Entity Type | Organization
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Legal Business Name | JWOA3 PLLC
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 7175 NOLENSVILLE RD STE 109
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City | NOLENSVILLE
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State | TN
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Zip | 37135-9655
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Country | US
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Telephone | 901-337-5367
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Fax |
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Provider Business Mailing Address
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Address Line | 7175 NOLENSVILLE RD STE 109
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City | NOLENSVILLE
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State | TN
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Zip | 37135-9655
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Country | US
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Telephone | 901-337-5367
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JARVIS WALTON
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Credential | MD
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Telephone | 901-246-2195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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