Search › Tennessee › 207Y00000X
Jordan Licata, DO
NPI 1952795106 · on the registry since 2015
Practice
- Address
- 1821 N Washington St
Tullahoma, TN 37388 - Phone
- (931) 461-5056
- Fax
- (931) 455-4450
- Organisation at this address
- Marvel Clinic P.C.
Ascent Anesthesia Llc
Center For Day Surgery
Integrated Facial Aesthetics, PllcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 9
Additional practice sites
- 1011 S Main St, Hopkinsville, KY
Registry record
- Primary taxonomy
- 207Y00000X
207Y00000X
- Also registered as
- 207Y00000X
- Licence states on file
- KY, TN
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2024-12-12
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Tennessee