Provider Demographics
NPI:1073122552
Name:JONES, ANTHONY DIMITRI
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DIMITRI
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 1:420 W 11TH ST APT 303
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-2226
Mailing Address - Country:US
Mailing Address - Phone:918-955-3602
Mailing Address - Fax:
Practice Address - Street 1:130 N GREENWOOD AVE STE 302
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-1446
Practice Address - Country:US
Practice Address - Phone:918-599-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator