Provider Demographics
NPI:1265478457
Name:HALL, JASON JENNINGS (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:JENNINGS
Last Name:HALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9239 PARK WEST BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4403
Mailing Address - Country:US
Mailing Address - Phone:865-973-9500
Mailing Address - Fax:865-973-9575
Practice Address - Street 1:9239 PARK WEST BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4403
Practice Address - Country:US
Practice Address - Phone:865-973-9500
Practice Address - Fax:865-973-9575
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2017-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM26332082S0099X
CAA1086412082S0099X
VA01012476462082S0099X
TN520852082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I245655OtherMEDICARE
TN2463107OtherHUMANA
TNQ012722OtherMEDICAID-TENNCARE
TN6040816OtherBCBS TN
TN9535632OtherCIGNA