Provider Demographics
NPI:1578632550
Name:JONES, SAMUEL OTTERSON IV (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:OTTERSON
Last Name:JONES
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2501 CITICO AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1127
Mailing Address - Country:US
Mailing Address - Phone:423-697-2000
Mailing Address - Fax:423-697-2118
Practice Address - Street 1:2501 CITICO AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1127
Practice Address - Country:US
Practice Address - Phone:423-697-2000
Practice Address - Fax:423-697-2118
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21364207RC0001X
TXN0142207RC0001X
TN55695207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CM507OtherBCBS
TX202417603Medicaid
TXP00898254OtherRAILROAD MEDICARE
TN55695OtherBOARD OF MEDICAL EXAMINERS
TN55695OtherBOARD OF MEDICAL EXAMINERS
TXTXB112505Medicare PIN