Provider Demographics
NPI:1740936939
Name:VERNON, ANTHONY JEROME (M A)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JEROME
Last Name:VERNON
Suffix:
Gender:M
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 KEITH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-4324
Mailing Address - Country:US
Mailing Address - Phone:423-458-6660
Mailing Address - Fax:423-339-2095
Practice Address - Street 1:3575 KEITH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4324
Practice Address - Country:US
Practice Address - Phone:423-458-6660
Practice Address - Fax:423-339-2095
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)