Provider Demographics
NPI:1477557064
Name:JONES, CLYDE MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:MICHAEL
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:80 HUMPHREYS CENTER DR STE 330
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2363
Practice Address - Country:US
Practice Address - Phone:901-752-6131
Practice Address - Fax:901-751-6170
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS157412207RH0003X
TN26351207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00122906Medicaid
TN3091352Medicaid
MS830000027Medicare PIN
MS00122906Medicaid
TN3091352Medicaid