Provider Demographics
NPI:1245057264
Name:COX, JASON DWIGHT
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DWIGHT
Last Name:COX
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 1:145 COX RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:WV
Mailing Address - Zip Code:25570-4816
Mailing Address - Country:US
Mailing Address - Phone:304-360-2003
Mailing Address - Fax:
Practice Address - Street 1:145 COX RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570-4816
Practice Address - Country:US
Practice Address - Phone:304-360-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-21
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency