Provider Demographics
NPI:1144293713
Name:JONES, TAMMY (MD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9683 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3755
Mailing Address - Country:US
Mailing Address - Phone:703-426-4900
Mailing Address - Fax:703-426-4954
Practice Address - Street 1:9683A MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3744
Practice Address - Country:US
Practice Address - Phone:703-426-4900
Practice Address - Fax:703-426-4954
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-00293207Q00000X
VA0101266007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCR810001OtherBCBS
VA1922561943OtherGROUP NPI
MDCR810001OtherBCBS
MD102862600Medicaid
NCG70376Medicare UPIN
NC891170PMedicaid
MD102862600Medicaid