Basic Information
| Provider Information | |||||||||
| NPI: | 1669441341 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HINTON | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | TAYLOR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 W ELK AVE STE 21 | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376432654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4235432584 | ||||||||
| FaxNumber: | 4237222060 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 PROFESSIONAL PARK DR | ||||||||
| Address2: | SUITE 21 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376046583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239268813 | ||||||||
| FaxNumber: | 4239268910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | MD25883 | TN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 3096354 | 05 | TN | MEDICAID |