Provider Demographics
NPI:1861093114
Name:JONES, JIMMIE WAYNE
Entity type:Individual
Prefix:
First Name:JIMMIE
Middle Name:WAYNE
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 STAFFORD DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44904-9562
Mailing Address - Country:US
Mailing Address - Phone:419-512-8193
Mailing Address - Fax:
Practice Address - Street 1:2838 STAFFORD DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44904-9562
Practice Address - Country:US
Practice Address - Phone:419-512-8193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide