Individual
JERRY WAYNE HORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATP
Contact information
Practice address
1901 S PALESTINE ST, ATHENS, TX 75751-5701
(903) 681-5449
Mailing address
1901 S PALESTINE ST, ATHENS, TX 75751-5701
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
88274
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88274
—
TX
Enumeration date
11/09/2018
Last updated
11/09/2018
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