MEDICARE: JONATHAN S AYCOCK DO

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	DO-858	AL

General Provider Information

NPI Number	:	1912972977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN S AYCOCK DO

Provider Business Mailing Address
First Line	:	2828 HIGHWAY 31 S
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-1538
Country	:	US
Telephone Number	:	256-353-2000
Fax Number	:	256-355-3470

Provider Business Practice Location Address
First Line	:	2828 HIGHWAY 31 S
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35603-1538
Country	:	US
Telephone Number	:	256-353-2000
Fax Number	:	256-355-3470

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	07/08/2007

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Directions to “ JONATHAN S AYCOCK DO” Practice Location

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