Basic Information
| Provider Information | |||||||||
| NPI: | 1114521051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRUM | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | CODY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1930 20TH AVENUE DR NE APT 22 | ||||||||
| Address2: | |||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286010511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286393397 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2675 COURT DR # B | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280541478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048244999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2020 | ||||||||
| LastUpdateDate: | 11/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | NC | Y |
No ID Information.