Provider Demographics
NPI:1275617052
Name:JONES, LISA PAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:PAYNE
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 1:57 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4836
Mailing Address - Country:US
Mailing Address - Phone:931-787-1950
Mailing Address - Fax:931-787-1953
Practice Address - Street 1:57 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4836
Practice Address - Country:US
Practice Address - Phone:931-787-1950
Practice Address - Fax:931-787-1953
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29645207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1510041Medicaid
TN4056462OtherBLUE CROSS
TN4056462OtherBLUE CROSS
TNH23585Medicare UPIN