Provider Demographics
NPI:1942326343
Name:JONES, CHARLES W (PT)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:JONES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4147
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415
Mailing Address - Country:US
Mailing Address - Phone:423-877-4599
Mailing Address - Fax:423-877-5611
Practice Address - Street 1:5000 ALPHA LN A
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4054
Practice Address - Country:US
Practice Address - Phone:423-877-4599
Practice Address - Fax:423-877-5611
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN95174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN003106308OtherBLUE CROSS BLUE SHIELS
TN446607Medicare ID - Type UnspecifiedMEDICARE