Provider Demographics
NPI:1538502984
Name:JONES, EDDIE CHARLES SR
Entity Type:Individual
Prefix:MR
First Name:EDDIE
Middle Name:CHARLES
Last Name:JONES
Suffix:SR
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 1:108 ASHTON CT
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-3010
Mailing Address - Country:US
Mailing Address - Phone:405-659-9189
Mailing Address - Fax:
Practice Address - Street 1:108 ASHTON CT
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-3010
Practice Address - Country:US
Practice Address - Phone:405-659-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS02251955101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health