Individual
JASON ALLEN PENDERGRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1200 MEMORIAL DR, DALTON, GA 30720-2529
(706) 272-6000
Mailing address
1200 MEMORIAL DR, DALTON, GA 30720-2529
(706) 272-6000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN199787
GA
Other
Enumeration date
01/05/2016
Last updated
02/29/2016
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