Provider Demographics
NPI:1235699117
Name:JONES, TIMOTHY TRAVIS
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:TRAVIS
Last Name:JONES
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 1:121 PARLIAMENT DR
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-6210
Mailing Address - Country:US
Mailing Address - Phone:865-977-8700
Mailing Address - Fax:865-223-7466
Practice Address - Street 1:121 PARLIAMENT DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-6210
Practice Address - Country:US
Practice Address - Phone:865-977-8700
Practice Address - Fax:865-223-7466
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN111491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty