Individual
JONATHAN BRENT ORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5118 N 1350TH ST, WATSON, IL 62473-2271
(404) 783-2146
Mailing address
5118 N 1350TH ST, WATSON, IL 62473-2271
(404) 783-2146
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
03/17/2020
Last updated
03/17/2020
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