Provider Demographics
NPI:1376921494
Name:JONES, EVAN G
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:G
Last Name:JONES
Suffix:
Gender:M
Credentials:
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 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5698
Mailing Address - Fax:
Practice Address - Street 1:15 JANE JACOBS RD STE 101
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-8308
Practice Address - Country:US
Practice Address - Phone:828-298-0333
Practice Address - Fax:828-298-0050
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100979207Q00000X
NC2021-00108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC207Q00000XOtherTAXONOMY
NC2021-00108OtherSTATE LICENSES
NCFJ7465734OtherDEA