=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669441341
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY TAYLOR HINTON M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2006
-----------------------------------------------------
Last Update Date | 02/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 PROFESSIONAL PARK DR SUITE 21
-----------------------------------------------------
City | JOHNSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37604-6583
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-926-8813
-----------------------------------------------------
Fax | 423-926-8910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1500 W ELK AVE STE 21
-----------------------------------------------------
City | ELIZABETHTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37643-2654
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-543-2584
-----------------------------------------------------
Fax | 423-722-2060
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | MD25883
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------