Provider Demographics
NPI:1417585027
Name:JONES, ERIC WESLEY (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WESLEY
Last Name:JONES
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 N SIZER AVE APT 178
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-5134
Mailing Address - Country:US
Mailing Address - Phone:423-335-4252
Mailing Address - Fax:
Practice Address - Street 1:275 W GREENE DR
Practice Address - Street 2:
Practice Address - City:MOSHEIM
Practice Address - State:TN
Practice Address - Zip Code:37818-6105
Practice Address - Country:US
Practice Address - Phone:423-422-4061
Practice Address - Fax:423-422-4430
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer