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General NPI Number Information
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NPI Number | 1932050812
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Entity Type | Organization
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Legal Business Name | JETHRO FAMILY MEDICINE
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Dates
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Enumeration Date | 02/05/2026
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Last Update Date | 02/27/2026
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Provider Practice Location Address
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Address Line | 212 W CAYUGA DR
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City | ATHENS
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State | TX
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Zip | 75751-3204
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Country | US
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Telephone | 903-675-5742
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Fax | 903-904-5234
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Provider Business Mailing Address
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Address Line | 212 W CAYUGA DR
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City | ATHENS
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State | TX
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Zip | 75751-3204
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Country | US
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Telephone | 903-675-5742
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Fax | 903-904-5234
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | SARAH JETHRO
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Credential | DO
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Telephone | 903-675-5742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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