Provider Demographics
NPI:1568442689
Name:KERLEY, JONATHAN M (DO)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:M
Last Name:KERLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 LEE HWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1799
Mailing Address - Country:US
Mailing Address - Phone:423-894-0432
Mailing Address - Fax:423-894-0475
Practice Address - Street 1:2372 LIFESTYLE WAY STE 152
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4940
Practice Address - Country:US
Practice Address - Phone:423-894-0432
Practice Address - Fax:423-894-0475
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007029189207P00000X
TN1427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3307028OtherMEDICARE PTAN
TN3370172OtherMEDICARE PTAN
TN3307024OtherMEDICARE PTAN
TN3726561OtherMEDICARE PTAN
TN3307024Medicaid
TN3307028OtherMEDICARE PTAN
H68424Medicare UPIN