Active NPI
Jodi Polaha Jones, PH.D.
- Clinical Psychologist
- Johnson City, TN
National Provider Identifier
1841472586
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P2737
- Practice address
- 917 W Walnut St
Johnson City, TN 37604-6527 - Phone
- (423) 439-6464
- Fax
- (423) 439-7118
- NPI assigned
- Dec 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2737 | TN | |
| Clinical Psychologist | 103TC0700X | P2737 | TN | Primary |
Addresses
Primary practice location
917 W Walnut St
Johnson City, TN 37604-6527
Mailing address
PO Box 699
Mountain Home, TN 37684-0699
Phone (423) 439-6464
Other practice location 1
315 W Locust St
Johnson City, TN 37604-6727
Phone (423) 946-0444
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1514093 | Medicaid | TN |
Other names 1
- Dr. Jodi Polaha
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P2737 | TN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196812800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705536000000",
"number": "1841472586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 699",
"city": "MOUNTAIN HOME",
"state": "TN",
"postal_code": "376840699",
"telephone_number": "423-439-6464",
"fax_number": "423-439-7118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "917 W WALNUT ST",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376046527",
"telephone_number": "423-439-6464",
"fax_number": "423-439-7118"
}
],
"practiceLocations": [
{
"address_1": "315 W Locust St",
"address_purpose": "LOCATION",
"city": "Johnson City",
"state": "TN",
"postal_code": "376046727",
"country_code": "US",
"telephone_number": "423-946-0444",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JONES",
"first_name": "JODI",
"middle_name": "POLAHA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-12-05",
"last_updated": "2024-01-18",
"certification_date": "2024-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "2737",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "P2737",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1514093",
"state": "TN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JODI",
"last_name": "POLAHA",
"prefix": "DR.",
"credential": "PH.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.