Provider Demographics
NPI:1891574612
Name:MILTON, JASON L JR
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:L
Last Name:MILTON
Suffix:JR
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 1:25 PARKLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1319
Mailing Address - Country:US
Mailing Address - Phone:740-403-9678
Mailing Address - Fax:
Practice Address - Street 1:25 PARKLAWN BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1319
Practice Address - Country:US
Practice Address - Phone:740-403-9678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide