Individual
JACOB B OLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 S WILLOW AVE, COOKEVILLE, TN 38501-4667
(931) 526-9518
(931) 372-0087
Mailing address
105 S WILLOW AVE, COOKEVILLE, TN 38501-4667
(931) 526-9518
(931) 372-0087
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PA03726
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q047209
—
TN
Enumeration date
09/17/2018
Last updated
10/10/2022
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