Provider Demographics
NPI:1134154081
Name:HOLLINGSWORTH, JASON L (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:L
Last Name:HOLLINGSWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1804 HIGHWAY 45 BYP
Mailing Address - Street 2:STE 604
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4436
Mailing Address - Country:US
Mailing Address - Phone:731-584-3151
Mailing Address - Fax:731-584-3168
Practice Address - Street 1:186 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1618
Practice Address - Country:US
Practice Address - Phone:731-584-3151
Practice Address - Fax:731-584-3168
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00271743OtherRR MEDICARE
TN3002034Medicaid
TN3002037Medicaid
4114640OtherBCBS
TN3002037Medicaid
TN3002034Medicare PIN
TNA96743Medicare UPIN