Provider Demographics
NPI:1164529525
Name:JONES, BETTY A (MD)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:A
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-3572
Mailing Address - Country:US
Mailing Address - Phone:843-248-4700
Mailing Address - Fax:843-248-3145
Practice Address - Street 1:1608 N MAIN STREET
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-3572
Practice Address - Country:US
Practice Address - Phone:843-386-3573
Practice Address - Fax:843-386-2617
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BJ2540119OtherDEA NUMBER
F52526Medicare UPIN