Provider Demographics
NPI:1992780696
Name:HEAD, JONATHAN M (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:HEAD
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 1:985 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6815
Mailing Address - Country:US
Mailing Address - Phone:615-984-1000
Mailing Address - Fax:615-984-1005
Practice Address - Street 1:985 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6815
Practice Address - Country:US
Practice Address - Phone:615-984-1000
Practice Address - Fax:615-984-1005
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400509207Q00000X
IA36634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP00314288OtherRAILROAD MEDICARE NONBILL
IA1992780696Medicaid
IAP00314288OtherRAILROAD MEDICARE NONBILL
IAI17538Medicare ID - Type UnspecifiedMEDICARE NONBILLING #