Provider Demographics
NPI:1124830609
Name:JONES, TOMMY TERRELL
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:TERRELL
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-8738
Mailing Address - Country:US
Mailing Address - Phone:567-318-9604
Mailing Address - Fax:
Practice Address - Street 1:122 S SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-8738
Practice Address - Country:US
Practice Address - Phone:567-318-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care