Provider Demographics
NPI:1639444912
Name:JONES, NADJA NADINE
Entity Type:Individual
Prefix:
First Name:NADJA
Middle Name:NADINE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-423-3791
Mailing Address - Fax:
Practice Address - Street 1:7772 HIGHWAY 23
Practice Address - Street 2:SUITE A
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037-2060
Practice Address - Country:US
Practice Address - Phone:504-371-9355
Practice Address - Fax:504-371-9383
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA208133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05335531Medicaid
LA2300873Medicaid
LA444384YH3UMedicare PIN