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NPI Code Detail

MEDICARE: DR. JASON MICHAEL HERNDON M.D.

MEDICARE: DR. JASON MICHAEL HERNDON M.D.
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
1207L00000XAnesthesiology PhysicianLL34897SC
2207LP2900XPain Medicine (Anesthesiology) PhysicianPMC0000000910TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871856302
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON MICHAEL HERNDON M.D.
Provider Business Mailing Address
First Line : 2345 MURFREESBORO HWY
Second Line :
City : MANCHESTER
State : TN
Zip : 37355-3206
Country : US
Telephone Number : 931-728-5607
Fax Number :
Provider Business Practice Location Address
First Line : 2345 MURFREESBORO HWY
Second Line :
City : MANCHESTER
State : TN
Zip : 37355-3206
Country : US
Telephone Number : 931-728-5607
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2012
Last Update Date : 08/11/2022

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