Basic Information
Provider Information
NPI: 1447693890
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OVERCASH
FirstName: JONATHAN
MiddleName: LANCE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 110 S ANNISTON AVE
Address2:  
City: SYLACAUGA
State: AL
PostalCode: 351502961
CountryCode: US
TelephoneNumber: 2562070200
FaxNumber: 2562070201
Practice Location
Address1: 110 S ANNISTON AVE
Address2:  
City: SYLACAUGA
State: AL
PostalCode: 351502961
CountryCode: US
TelephoneNumber: 2562070200
FaxNumber: 2562070201
Other Information
ProviderEnumerationDate: 04/15/2013
LastUpdateDate: 08/19/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X38414ALY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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