Individual
JERRY LABRON RAGON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8 W 8TH ST, CHICKAMAUGA, GA 30707-1308
(423) 802-9804
(877) 259-6370
Mailing address
8 W 8TH ST, CHICKAMAUGA, GA 30707-1308
(423) 802-9804
(877) 259-6370
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
6357
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H445385
TNCARE PROVIDER NUMBER
TN
Enumeration date
05/04/2010
Last updated
05/04/2010
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