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General NPI Number Information
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NPI Number | 1316705304
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Entity Type | Individual
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Provider Name | JABARI TARIQ MCCLENDON CRT
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Gender | Male
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Dates
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Enumeration Date | 03/13/2024
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 5114 SPINNAKER LN
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City | KING GEORGE
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State | VA
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Zip | 22485-3163
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Country | US
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Telephone | 757-270-6181
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Fax |
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Provider Business Mailing Address
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Address Line | 5114 SPINNAKER LN
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City | KING GEORGE
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State | VA
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Zip | 22485-3163
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Country | US
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Telephone | 757-270-6181
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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 | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number | 0117009294
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License Number State | VA
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