Individual
JASON S. HALLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2525 DESALES AVENUE, CHATTANOOGA, TN 37404
(423) 697-0014
(423) 648-6280
Mailing address
725 GLENWOOD DRIVE,, SUITE E-487, CHATTANOOGA, TN 37404
(423) 697-0014
(423) 648-6280
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
PA1317
TN
363A00000X
Physician Assistant
Primary
PA1317
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257502672A
—
GA
01
—
3370172
MEDICARE PTAN
TN
01
—
3664283
MEDICARE PTAN
TN
01
—
36642831
MEDICARE PTAN
TN
01
—
3726561
MEDICARE PTAN
TN
01
—
4116090
BCBS OF TENNESSEE
TN
Enumeration date
06/19/2006
Last updated
02/12/2021
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