=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841328747
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RASONE T JONES DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2007
-----------------------------------------------------
Last Update Date | 09/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5366 MENDENHALL MALL
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38115-4505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-271-6156
-----------------------------------------------------
Fax | 901-271-6195
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2595 CENTRAL AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38104-5905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-260-8551
-----------------------------------------------------
Fax | 901-260-8590
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 8637
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------