Provider Demographics
NPI:1619177086
Name:JONES, ANGELA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MICHELLE
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 1:151 E METRO DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-4402
Mailing Address - Country:US
Mailing Address - Phone:601-992-3288
Mailing Address - Fax:601-992-3188
Practice Address - Street 1:151 E METRO DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-4402
Practice Address - Country:US
Practice Address - Phone:601-992-3288
Practice Address - Fax:601-992-3188
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-1806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
753068151002OtherTRICARE
753068151OtherMHP
753068151Other1ST CHOICE
MS02357749Medicaid
7607991OtherAETNA
753068151OtherMPCN
168390709OtherDOL
753068151OtherUHC
MS$$$$$$$$$COtherBCBS - CLINTON
753068151OtherUHC
MS02357749Medicaid
MS$$$$$$$$$OtherBCBS - DOGWOOD
753068151OtherMPCN
7607991OtherAETNA
753068151OtherMHP