Provider Demographics
NPI:1073566352
Name:JONES, KIM RICHARD (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:RICHARD
Last Name:JONES
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 VILCOM CTR
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-1689
Mailing Address - Country:US
Mailing Address - Phone:919-942-7278
Mailing Address - Fax:919-942-9029
Practice Address - Street 1:55 VILCOM CTR
Practice Address - Street 2:SUITE 140
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-1689
Practice Address - Country:US
Practice Address - Phone:919-942-7278
Practice Address - Fax:919-942-9029
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32319174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE06697Medicare UPIN
NC8947146Medicare ID - Type UnspecifiedMEDICARE
NC212977KMedicare ID - Type UnspecifiedMEDICARE