Provider Demographics
NPI:1598092629
Name:MCDONALD, JESSIE D II
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:D
Last Name:MCDONALD
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 W IRIS DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3191
Mailing Address - Country:US
Mailing Address - Phone:615-269-5170
Mailing Address - Fax:615-269-8015
Practice Address - Street 1:654 W IRIS DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-3191
Practice Address - Country:US
Practice Address - Phone:615-269-5170
Practice Address - Fax:615-269-8015
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness