Provider Demographics
NPI:1639714454
Name:ATKINSON, JERRID SR
Entity type:Individual
Prefix:
First Name:JERRID
Middle Name:
Last Name:ATKINSON
Suffix:SR
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 1:193 LINDSEY RD
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1140
Mailing Address - Country:US
Mailing Address - Phone:216-376-4919
Mailing Address - Fax:
Practice Address - Street 1:193 LINDSEY RD
Practice Address - Street 2:
Practice Address - City:MUNROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262-1140
Practice Address - Country:US
Practice Address - Phone:216-376-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management