=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477517167
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON R KNOX DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2006
-----------------------------------------------------
Last Update Date | 01/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 STONECREST BLVD STE 350
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37167-6860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-220-8788
-----------------------------------------------------
Fax | 615-220-8688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 STONECREST BLVD STE 350
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37167-6860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-220-8788
-----------------------------------------------------
Fax | 615-220-8688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | DPM710
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 307187-501
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | DPM200005
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------