Provider Demographics
NPI:1912972977
Name:AYCOCK, JONATHAN S (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:S
Last Name:AYCOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 HIGHWAY 31 S
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-1538
Mailing Address - Country:US
Mailing Address - Phone:256-353-2000
Mailing Address - Fax:256-355-3470
Practice Address - Street 1:2828 HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-1538
Practice Address - Country:US
Practice Address - Phone:256-353-2000
Practice Address - Fax:256-355-3470
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALDO-858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH87253Medicare UPIN