Provider Demographics
NPI:1396386918
Name:JONES, RUDOLPH DELANDO III
Entity Type:Individual
Prefix:MR
First Name:RUDOLPH
Middle Name:DELANDO
Last Name:JONES
Suffix:III
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 1:15013 KEELERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:VA
Mailing Address - Zip Code:23840-2835
Mailing Address - Country:US
Mailing Address - Phone:804-971-5278
Mailing Address - Fax:
Practice Address - Street 1:15013 KEELERS MILL RD
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:VA
Practice Address - Zip Code:23840-2835
Practice Address - Country:US
Practice Address - Phone:804-971-5278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT62546046343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VATRANSPORTATIONMedicaid
VA15013Medicaid