Provider Demographics
NPI:1003393067
Name:JONES, ALONZO
Entity Type:Individual
Prefix:
First Name:ALONZO
Middle Name:
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 1:5617 HORNADAY RD UNIT J
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2924
Mailing Address - Country:US
Mailing Address - Phone:336-987-9303
Mailing Address - Fax:
Practice Address - Street 1:5617 HORNADAY RD
Practice Address - Street 2:UNIT J
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409
Practice Address - Country:US
Practice Address - Phone:336-987-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2848951335G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335G00000XSuppliersMedical Foods Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC41-2233656OtherTRIFECTATRANSPOTATION SERVICES