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General NPI Number Information
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NPI Number | 1710183470
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Entity Type | Individual
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Provider Name | JASON LEE HARDIN MD
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Gender | Male
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 02/03/2017
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Provider Practice Location Address
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Address Line | 1 MEDICAL CENTER BLVD
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City | COOKEVILLE
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State | TN
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Zip | 38501-4294
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Country | US
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Telephone | 931-783-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 1776 HICKORY CV
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City | COOKEVILLE
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State | TN
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Zip | 38506-6385
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Country | US
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Telephone | 865-696-6871
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 47339
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License Number State | TN
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