Provider Demographics
NPI:1609905942
Name:AMONETTE, JON BLAKE
Entity Type:Individual
Prefix:MR
First Name:JON
Middle Name:BLAKE
Last Name:AMONETTE
Suffix:
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 1:1222 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6402
Mailing Address - Country:US
Mailing Address - Phone:931-490-1586
Mailing Address - Fax:
Practice Address - Street 1:1222 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6402
Practice Address - Country:US
Practice Address - Phone:931-490-1586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health