Basic Information
Provider Information
NPI: 1003149147
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RIGGS
FirstName: JONATHAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 206 BEDFORD WAY
Address2:  
City: FRANKLIN
State: TN
PostalCode: 370645526
CountryCode: US
TelephoneNumber: 6157903290
FaxNumber: 6157948845
Practice Location
Address1: 206 BEDFORD WAY
Address2:  
City: FRANKLIN
State: TN
PostalCode: 370645526
CountryCode: US
TelephoneNumber: 6157903290
FaxNumber: 6157948845
Other Information
ProviderEnumerationDate: 09/08/2009
LastUpdateDate: 12/08/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA2786TNY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000XPA3852MAN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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