Provider Demographics
NPI:1245214451
Name:JONES, GREGORY SANSOM (PHD)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SANSOM
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 W RIDGE ST STE 2
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2142
Mailing Address - Country:US
Mailing Address - Phone:906-228-6200
Mailing Address - Fax:906-228-6224
Practice Address - Street 1:1300 W RIDGE ST STE 2
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2142
Practice Address - Country:US
Practice Address - Phone:906-228-6200
Practice Address - Fax:906-228-6224
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010832103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00282476OtherRAILROAD MEDICARE
MIDW5644OtherRAILROAD MEDICARE
MI7253OtherMEDICARE PIN