Healthcare Provider Details

I. General information

NPI: 1053560797
Provider Name (Legal Business Name): ANITA KAY JONES PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 GLENWOOD DR SUITE 208
CHATTANOOGA TN
37404-1108
US

IV. Provider business mailing address

6201 GREENLEIGH AVE FL 2
MIDDLE RIVER MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 423-495-7736
  • Fax: 423-495-7718
Mailing address:
  • Phone: 410-933-2704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0009504
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA0000001598
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: