MEDICARE: JONATHAN AARON BOGGS SOCIAL WORKER

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	104100000X	Social Worker	NA	TN
2	104100000X	Social Worker	PENDING	TN

General Provider Information

NPI Number	:	1356954747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN AARON BOGGS SOCIAL WORKER

Provider Business Mailing Address
First Line	:	1557 DOWNTOWN WEST BLVD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5407
Country	:	US
Telephone Number	:	865-545-4592
Fax Number	:	865-693-8554

Provider Business Practice Location Address
First Line	:	1557 DOWNTOWN WEST BLVD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5407
Country	:	US
Telephone Number	:	865-545-4592
Fax Number	:	865-693-8554

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

Provider Enumeration Date	:	08/26/2020
Last Update Date	:	08/26/2020

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