Provider Demographics
NPI:1619019502
Name:RATLIFF, JASON LEWIS
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LEWIS
Last Name:RATLIFF
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 1:257 HILL TOP CIR
Mailing Address - Street 2:
Mailing Address - City:BLUFF CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37618-1632
Mailing Address - Country:US
Mailing Address - Phone:423-366-3177
Mailing Address - Fax:
Practice Address - Street 1:404 HOLSTON DR
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-3126
Practice Address - Country:US
Practice Address - Phone:423-638-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3697678OtherMEDICARE
TN3013231Medicaid