Provider Demographics
NPI:1306976352
Name:CLARENCE L JONES MD PC
Entity type:Organization
Organization Name:CLARENCE L JONES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:931-526-7104
Mailing Address - Street 1:222 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2438
Mailing Address - Country:US
Mailing Address - Phone:931-526-7104
Mailing Address - Fax:931-526-7105
Practice Address - Street 1:222 N OAK AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2438
Practice Address - Country:US
Practice Address - Phone:931-526-7104
Practice Address - Fax:931-526-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2004047OtherBCBS
TN3387304Medicare PIN
B00797Medicare UPIN