Individual
JONATHAN PARKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
95 RIVERPORT DR, JACKSON, TN 38301-5748
(731) 298-4506
Mailing address
95 RIVERPORT DR, JACKSON, TN 38301-5748
(731) 298-4506
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
163940
TN
Other
Enumeration date
09/13/2016
Last updated
01/11/2017
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