Provider Demographics
NPI:1447325634
Name:LIPMAN, JONATHAN JOSEPH (PHD MIBIOL CNS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JOSEPH
Last Name:LIPMAN
Suffix:
Gender:M
Credentials:PHD MIBIOL CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 HAWK RDG
Mailing Address - Street 2:
Mailing Address - City:UNICOI
Mailing Address - State:TN
Mailing Address - Zip Code:37692-4374
Mailing Address - Country:US
Mailing Address - Phone:423-743-5300
Mailing Address - Fax:
Practice Address - Street 1:150 HAWK RDG
Practice Address - Street 2:
Practice Address - City:UNICOI
Practice Address - State:TN
Practice Address - Zip Code:37692-4374
Practice Address - Country:US
Practice Address - Phone:423-743-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.004044133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist