Provider Demographics
NPI:1245973734
Name:SLEDD, JONATHAN ELLIOTT (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ELLIOTT
Last Name:SLEDD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 RIVERCHASE DR
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-7483
Mailing Address - Country:US
Mailing Address - Phone:334-732-3083
Mailing Address - Fax:
Practice Address - Street 1:4401 RIVER CHASE DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:38667
Practice Address - Country:US
Practice Address - Phone:706-703-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program