Provider Demographics
NPI:1730225392
Name:CHARLES W JONES MD PA
Entity type:Organization
Organization Name:CHARLES W JONES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-246-7779
Mailing Address - Street 1:PO BOX 1509
Mailing Address - Street 2:200 HOSPITAL AVE SUITE 5
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-1509
Mailing Address - Country:US
Mailing Address - Phone:336-246-7779
Mailing Address - Fax:336-846-8370
Practice Address - Street 1:200 HOSPITAL AVE STE 5
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9244
Practice Address - Country:US
Practice Address - Phone:336-246-7779
Practice Address - Fax:336-846-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700607208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC81528OtherMEDCOST
NC891046LMedicaid
NC26782OtherPARTNERS MEDICARE #
NC1046LOtherBCBS NC #
NCP00182199OtherRAILROAD MEDICARE
NC=========OtherEIN
NC891046LMedicaid
NC232040Medicare PIN