Provider Demographics
NPI:1811165608
Name:HAFNER, JONATHAN WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:WILLIAM
Last Name:HAFNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 8888620
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-0001
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6198
Practice Address - Street 1:49 CLEVELAND ST STE 220
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-2854
Practice Address - Country:US
Practice Address - Phone:931-219-9990
Practice Address - Fax:931-717-1180
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53596207Y00000X
MN50510207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB117425Medicare PIN