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General NPI Number Information
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NPI Number | 1417585027
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Entity Type | Individual
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Provider Name | ERIC WESLEY JONES LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 03/30/2020
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 275 W GREENE DR
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City | MOSHEIM
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State | TN
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Zip | 37818-6105
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Country | US
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Telephone | 423-422-4061
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Fax | 423-422-4430
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Provider Business Mailing Address
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Address Line | 2021 N SIZER AVE APT 178
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City | JEFFERSON CITY
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State | TN
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Zip | 37760-5134
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Country | US
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Telephone | 423-335-4252
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2037
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License Number State | TN
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