Basic Information
| Provider Information | |||||||||
| NPI: | 1700118411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAMAR | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | SHREVE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1214 TOPSIDE RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377775505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659707747 | ||||||||
| FaxNumber: | 8656812266 | ||||||||
| Practice Location | |||||||||
| Address1: | 1214 TOPSIDE RD | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377775505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659707747 | ||||||||
| FaxNumber: | 8656812266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2010 | ||||||||
| LastUpdateDate: | 09/10/2013 | ||||||||
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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 | 363A00000X | 1821 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.