Provider Demographics
NPI:1003998329
Name:JONES, DOUGLAS EDGAR (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:EDGAR
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 PARK AVE #307
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119
Mailing Address - Country:US
Mailing Address - Phone:901-682-0004
Mailing Address - Fax:901-680-8218
Practice Address - Street 1:6005 PARK AVENUE
Practice Address - Street 2:SUITE 307
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-5213
Practice Address - Country:US
Practice Address - Phone:901-682-0004
Practice Address - Fax:901-680-8218
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD18524207R00000X, 208VP0000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3031241Medicaid
TN3031241Medicaid
1031798107Medicare PIN
1031798107Medicare PIN