Provider Demographics
NPI:1407497621
Name:JONES, RANDALL K
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:K
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 1:1283 SIMPSON HIGHWAY 149
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-5443
Mailing Address - Country:US
Mailing Address - Phone:601-287-2745
Mailing Address - Fax:
Practice Address - Street 1:706 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2366
Practice Address - Country:US
Practice Address - Phone:601-990-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health