Basic Information
| Provider Information | |||||||||
| NPI: | 1467816652 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLRED | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | JACOB | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1168 | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385561168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234449584 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1924 ALCOA HWY | ||||||||
| Address2: | U.T. MEDICAL CENTER | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37920 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8653059340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2016 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | 57895 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.