Provider Demographics
NPI:1508120767
Name:JONES, SETH ELIJAH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:ELIJAH
Last Name:JONES
Suffix:
Gender:M
Credentials:PA-C
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 2489
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-6489
Mailing Address - Country:US
Mailing Address - Phone:434-382-1139
Mailing Address - Fax:434-525-5748
Practice Address - Street 1:20304 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7222
Practice Address - Country:US
Practice Address - Phone:434-237-6471
Practice Address - Fax:434-237-8810
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003910363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508120767Medicaid
VAVV9490AMedicare PIN