Provider Demographics
NPI:1891788840
Name:JAMESON, CHET HOUSTON III (MD)
Entity type:Individual
Prefix:
First Name:CHET
Middle Name:HOUSTON
Last Name:JAMESON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:854 W JAMES CAMPBELL BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-4659
Mailing Address - Country:US
Mailing Address - Phone:931-381-3872
Mailing Address - Fax:931-381-3883
Practice Address - Street 1:1222 TROTWOOD AVE
Practice Address - Street 2:SUITE 603
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6436
Practice Address - Country:US
Practice Address - Phone:931-381-3872
Practice Address - Fax:931-381-3883
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
19605174400000X
TN19605207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3710089Medicaid
3710089Medicare PIN
TN3710089Medicaid
3045781Medicare ID - Type Unspecified