Provider Demographics
NPI:1366485179
Name:MACNAUGHTON, JON MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:MARK
Last Name:MACNAUGHTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:MARK
Other - Last Name:MACNAUGHTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:208 GLEN MAR DR
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-3960
Mailing Address - Country:US
Mailing Address - Phone:865-986-4316
Mailing Address - Fax:865-567-2735
Practice Address - Street 1:10810 PARKSIDE DR STE 109
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1980
Practice Address - Country:US
Practice Address - Phone:865-218-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD023561207X00000X
TN23561207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ004845Medicaid
TN3373632OtherMEDICARE GROUP PTAN
TN6186158OtherBCBS
TN3069679Medicaid
TN4232034OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
TNT07653BOtherMEDICARE