Basic Information
| Provider Information | |||||||||
| NPI: | 1336435551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KILMER | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 975 E. THIRD STREET | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237785630 | ||||||||
| FaxNumber: | 4237783146 | ||||||||
| Practice Location | |||||||||
| Address1: | 975 E. THIRD STREET | ||||||||
| Address2: | ATTN: PROVIDER ENROLLMENT | ||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374032147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232661490 | ||||||||
| FaxNumber: | 4237782108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2011 | ||||||||
| LastUpdateDate: | 07/31/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2902 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.