Provider Demographics
NPI:1629380639
Name:JONES, CANDICE JOHNSON (DO)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:JOHNSON
Last Name:JONES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:LEANNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1132 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-1310
Mailing Address - Country:US
Mailing Address - Phone:731-983-3175
Mailing Address - Fax:
Practice Address - Street 1:1132 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-1310
Practice Address - Country:US
Practice Address - Phone:731-983-3175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS22203207Q00000X
TN2998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine