Provider Demographics
NPI:1508886458
Name:JONES, AUDREY SG (MD)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:SG
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E GREENVILLE ST
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1580
Mailing Address - Country:US
Mailing Address - Phone:864-260-1590
Mailing Address - Fax:864-260-1596
Practice Address - Street 1:101 SHIRLEY ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670-1824
Practice Address - Country:US
Practice Address - Phone:864-646-7522
Practice Address - Fax:864-646-3377
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC237050Medicaid
SCH87890Medicare UPIN
SC237050Medicaid
SC7043Medicare PIN