Individual
MR. JASON CURTIS FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
405 ORCHARD RD, ELIZABETHTON, TN 37643-4022
(423) 342-6177
Mailing address
405 ORCHARD RD, ELIZABETHTON, TN 37643-4022
(423) 342-6177
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
71626
TN
Other
Enumeration date
10/09/2007
Last updated
10/09/2007
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