Provider Demographics
NPI:1003367210
Name:JENNINGS, JOHNATHAN CHARLES
Entity Type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:CHARLES
Last Name:JENNINGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10327 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-6716
Mailing Address - Country:US
Mailing Address - Phone:804-754-3600
Mailing Address - Fax:804-754-1411
Practice Address - Street 1:10327 W BROAD ST
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-6716
Practice Address - Country:US
Practice Address - Phone:804-754-3600
Practice Address - Fax:804-754-1411
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001628237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist