Provider Demographics
NPI:1053479139
Name:JONES, LESLEY ANN (MD)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:ANN
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 BROOKSIDE DRIVE
Mailing Address - Street 2:STE 6
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4645
Mailing Address - Country:US
Mailing Address - Phone:423-247-0462
Mailing Address - Fax:423-247-0465
Practice Address - Street 1:2012 BROOKSIDE DR
Practice Address - Street 2:STE 6
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4645
Practice Address - Country:US
Practice Address - Phone:423-247-0462
Practice Address - Fax:423-247-0465
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049268207Q00000X
TNMD0000024370207Q00000X
NC35148207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3108307OtherBCBS OF TN
00325400OtherANTHEM BCBS
TN3108307Medicaid
F54844Medicare UPIN
TN3108307Medicaid