Provider Demographics
NPI:1386303113
Name:ALDRIDGE, JASON A
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:A
Last Name:ALDRIDGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703-7013
Mailing Address - Country:US
Mailing Address - Phone:706-602-8200
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITAL CT
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2077
Practice Address - Country:US
Practice Address - Phone:706-602-8200
Practice Address - Fax:706-602-1354
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN199207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily