Provider Demographics
NPI:1841403243
Name:JONESBOROUGH MEDICAL PLLC
Entity Type:Organization
Organization Name:JONESBOROUGH MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOUSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NASERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-753-6077
Mailing Address - Street 1:1003 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-1538
Mailing Address - Country:US
Mailing Address - Phone:423-753-6077
Mailing Address - Fax:
Practice Address - Street 1:1003 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1538
Practice Address - Country:US
Practice Address - Phone:423-753-6077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6456305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization