Provider Demographics
NPI:1578842068
Name:JONES, JOHNNIE RAY JR (RD)
Entity Type:Individual
Prefix:MR
First Name:JOHNNIE
Middle Name:RAY
Last Name:JONES
Suffix:JR
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4580 ANTELOPE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3183
Mailing Address - Country:US
Mailing Address - Phone:828-226-4283
Mailing Address - Fax:
Practice Address - Street 1:4580 ANTELOPE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3183
Practice Address - Country:US
Practice Address - Phone:828-226-4283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL003118133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered