MEDICARE: MARY JO ZINNANTI

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	103K00000X	Behavior Analyst	748	TN

General Provider Information

NPI Number	:	1174102131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JO ZINNANTI

Provider Business Mailing Address
First Line	:	107 KINCHLOE CT
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-3062
Country	:	US
Telephone Number	:	865-806-3190
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 AMERICAN WAY STE 109
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-5892
Country	:	US
Telephone Number	:	423-530-7600
Fax Number	:

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

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	04/06/2021

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