Provider Demographics
NPI:1104085067
Name:MERIWETHER, JONATHAN MORROW (PA-C)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:MORROW
Last Name:MERIWETHER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 NORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3708
Mailing Address - Country:US
Mailing Address - Phone:615-695-1432
Mailing Address - Fax:615-695-1483
Practice Address - Street 1:4230 HARDING RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2013
Practice Address - Country:US
Practice Address - Phone:615-383-2693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA1590363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3665221Medicare PIN