Provider Demographics
NPI:1093830341
Name:JONES EDWARDS PROFESSIONAL SERVICES.DBA
Entity Type:Organization
Organization Name:JONES EDWARDS PROFESSIONAL SERVICES.DBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:JONES
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:336-279-1000
Mailing Address - Street 1:1113 E WENDOVER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-6773
Mailing Address - Country:US
Mailing Address - Phone:336-279-1000
Mailing Address - Fax:336-279-1066
Practice Address - Street 1:1113 E WENDOVER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6773
Practice Address - Country:US
Practice Address - Phone:336-279-1000
Practice Address - Fax:336-279-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83000379251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300379Medicaid