Provider Demographics
NPI:1609956374
Name:SPALDING, JAY ARTHUR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ARTHUR
Last Name:SPALDING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3026
Mailing Address - Country:US
Mailing Address - Phone:423-756-2894
Mailing Address - Fax:423-756-2899
Practice Address - Street 1:1815 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3026
Practice Address - Country:US
Practice Address - Phone:423-756-2894
Practice Address - Fax:423-756-2899
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1306103TC1900X
GA1035103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
3980636Medicare ID - Type Unspecified
TN0082659OtherBCBS
TN3980635Medicaid
GA000745599CMedicaid
621362855OtherCHAMPUS/TRICARE
680015467OtherMEDICARE RR
S83171Medicare UPIN