Provider Demographics
NPI:1235821869
Name:JEFFERSON, PAUL SCOTT JR (LMT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:SCOTT
Last Name:JEFFERSON
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 S SPRINGS DR STE 208
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-1712
Mailing Address - Country:US
Mailing Address - Phone:615-378-8018
Mailing Address - Fax:
Practice Address - Street 1:7105 S SPRINGS DR STE 208
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-1712
Practice Address - Country:US
Practice Address - Phone:615-378-8018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7963225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist