Ayres, Jack Kennington

Ayres, Jack Kennington is an sole proprietor health care provider with primary practice located at 549 Hc/Baach Unit 15245, Daegu GYIONGSANGNAM 96271. He recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as his primary health care specialty. Ayres, Jack Kennington can be contacted via phone (315) 764-5595.

Contact Information

Primary practice address
549 Hc/Baach Unit 15245 Daegu GYIONGSANGNAM 96271
Phone: (315) 764-5595
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 0101266126 Virginia

Profile Details

NPI number 1679008510
LBN Legal business name Ayres, Jack Kennington
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 28th, 2017
Last updated Oct 7th, 2020 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679008510 NPPES
Virginia MEDICAID 0101266126

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