Provider Demographics
NPI:1407801541
Name:JONES, CORLISS (MD)
Entity Type:Individual
Prefix:MRS
First Name:CORLISS
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CORLISS
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531
Mailing Address - Country:US
Mailing Address - Phone:434-432-4443
Mailing Address - Fax:434-432-3555
Practice Address - Street 1:4 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-5436
Practice Address - Country:US
Practice Address - Phone:434-432-4443
Practice Address - Fax:434-432-3555
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101050629208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H24195Medicare UPIN