Provider Demographics
NPI:1578913836
Name:RISK, JONATHAN DAVID I
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:DAVID
Last Name:RISK
Suffix:I
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 1:1200 NC HIGHWAY 194 N
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-8133
Mailing Address - Country:US
Mailing Address - Phone:336-876-6262
Mailing Address - Fax:
Practice Address - Street 1:1200 NC HIGHWAY 194 N
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-8133
Practice Address - Country:US
Practice Address - Phone:336-876-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter