Provider Demographics
NPI:1295222842
Name:TONIA JACKSON MD
Entity Type:Organization
Organization Name:TONIA JACKSON MD
Other - Org Name:TOTAL PATIENT MANAGEMENT
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-847-7778
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:TN
Mailing Address - Zip Code:38363-0366
Mailing Address - Country:US
Mailing Address - Phone:731-847-7778
Mailing Address - Fax:
Practice Address - Street 1:766 TENNESSEE AVE S
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:TN
Practice Address - Zip Code:38363-4607
Practice Address - Country:US
Practice Address - Phone:731-847-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3889561Medicaid