MEDICARE: JASON L HOLLINGSWORTH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	13614	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00271743	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	4114640	OTHER	BCBS

General Provider Information

NPI Number	:	1134154081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON L HOLLINGSWORTH MD

Provider Business Mailing Address
First Line	:	1804 HIGHWAY 45 BYP
Second Line	:	STE 604
City	:	JACKSON
State	:	TN
Zip	:	38305-4436
Country	:	US
Telephone Number	:	731-584-3151
Fax Number	:	731-584-3168

Provider Business Practice Location Address
First Line	:	186 HOSPITAL DR
Second Line	:
City	:	CAMDEN
State	:	TN
Zip	:	38320-1618
Country	:	US
Telephone Number	:	731-584-3151
Fax Number	:	731-584-3168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	01/25/2016

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Directions to “ JASON L HOLLINGSWORTH MD” Practice Location

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