Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 57198 | TN |
NPI | 1699162354 |
---|---|
Provider Name | Mary Samantha Jones |
First Address | Memphis, TN 38119-0213 |
Second Address | Memphis, TN 38163-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 29/12/2021 |