Provider Demographics
NPI:1003871526
Name:JONES, MELVIN BLAINE III (MD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:BLAINE
Last Name:JONES
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 66
Mailing Address - Street 2:
Mailing Address - City:SURGOINSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37873
Mailing Address - Country:US
Mailing Address - Phone:423-345-6271
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:114 BELLAMY AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SURGOINSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37873
Practice Address - Country:US
Practice Address - Phone:423-345-6271
Practice Address - Fax:423-272-7667
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN024735207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3827275Medicaid
VA005633095Medicaid
VA005633095Medicaid
TN3827275Medicaid
F70156Medicare UPIN