Provider Demographics
NPI:1124035993
Name:JONES, CHARLES WOODROW JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WOODROW
Last Name:JONES
Suffix:JR
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:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:RATCLIFF
Mailing Address - State:AR
Mailing Address - Zip Code:72951
Mailing Address - Country:US
Mailing Address - Phone:479-431-2050
Mailing Address - Fax:479-431-2051
Practice Address - Street 1:9755 W ST HWY 22
Practice Address - Street 2:
Practice Address - City:RATCLIFF
Practice Address - State:AR
Practice Address - Zip Code:72951
Practice Address - Country:US
Practice Address - Phone:479-431-2050
Practice Address - Fax:479-431-2051
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-6627207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR111705001Medicaid
C68165Medicare UPIN
51391Medicare ID - Type Unspecified