Provider Demographics
NPI:1013001189
Name:JONES, MATTHEW BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BRIAN
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CIRCLE J DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1980
Mailing Address - Country:US
Mailing Address - Phone:601-425-0092
Mailing Address - Fax:601-425-0473
Practice Address - Street 1:30 CIRCLE J DR
Practice Address - Street 2:SUITE 1
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1980
Practice Address - Country:US
Practice Address - Phone:601-425-0092
Practice Address - Fax:601-425-0473
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17025261QP2300X, 207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00126035Medicaid
MS00126035Medicaid
MSH70113Medicare UPIN