Provider Demographics
NPI:1902005895
Name:JONES, JESSE (PHD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:JONES
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 1:1000 E 3RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2106
Mailing Address - Country:US
Mailing Address - Phone:423-622-0500
Mailing Address - Fax:423-622-0564
Practice Address - Street 1:6563 STAGE OAKS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2886
Practice Address - Country:US
Practice Address - Phone:901-937-5234
Practice Address - Fax:901-937-5237
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN843103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3680008Medicaid
TN3680008Medicaid