Healthcare Provider Details

I. General information

NPI: 1902961113
Provider Name (Legal Business Name): C MICHAEL JONES MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 WOLF RIVER CIR
GERMANTOWN TN
38138-1734
US

IV. Provider business mailing address

7710 WOLF RIVER CIR
GERMANTOWN TN
38138-1734
US

V. Phone/Fax

Practice location:
  • Phone: 901-685-5969
  • Fax: 901-665-6424
Mailing address:
  • Phone: 901-685-5969
  • Fax: 901-665-6424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number0000003590
License Number StateTN

VIII. Authorized Official

Name: ASHLEY MCCLURE
Title or Position: PHARM MGR
Credential: RPH
Phone: 901-685-5969