Provider Demographics
NPI:1336286533
Name:JONES, CHARLES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:
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 1:211 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HUGHES
Mailing Address - State:AR
Mailing Address - Zip Code:72348-9704
Mailing Address - Country:US
Mailing Address - Phone:870-339-5006
Mailing Address - Fax:833-415-0351
Practice Address - Street 1:211 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HUGHES
Practice Address - State:AR
Practice Address - Zip Code:72348-9704
Practice Address - Country:US
Practice Address - Phone:870-339-5006
Practice Address - Fax:833-415-0351
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ART2007-016207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR168502001Medicaid
AR5N920OtherBLUE CROSS
ARE5115OtherMEDICAL LICENSE
ARE5115OtherMEDICAL LICENSE