Provider Demographics
NPI:1346963873
Name:BETHEL, JAIME WATSON
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:WATSON
Last Name:BETHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:496 HOMESTEAD TRL
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:VA
Mailing Address - Zip Code:24586-5154
Mailing Address - Country:US
Mailing Address - Phone:434-770-6836
Mailing Address - Fax:434-373-8053
Practice Address - Street 1:208 N UNION ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1030
Practice Address - Country:US
Practice Address - Phone:434-770-6836
Practice Address - Fax:434-373-8053
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver