Provider Demographics
NPI:1689422883
Name:WILLARD, JONATHAN E (EDD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:E
Last Name:WILLARD
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 BRAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-2800
Mailing Address - Country:US
Mailing Address - Phone:423-653-4133
Mailing Address - Fax:
Practice Address - Street 1:6217 BRAMBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-2800
Practice Address - Country:US
Practice Address - Phone:423-653-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician