Provider Demographics
NPI:1033469416
Name:WITHROW, JEFFREY ANDREW (ATC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ANDREW
Last Name:WITHROW
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 JIM MCLEMORE RD
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-8542
Mailing Address - Country:US
Mailing Address - Phone:256-503-7798
Mailing Address - Fax:
Practice Address - Street 1:530 JIM MCLEMORE RD
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-8542
Practice Address - Country:US
Practice Address - Phone:256-503-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL810172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker