Provider Demographics
NPI:1750820080
Name:JONES, GROVER III
Entity Type:Individual
Prefix:MR
First Name:GROVER
Middle Name:
Last Name:JONES
Suffix:III
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 1:14304 N FENTON RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-1544
Mailing Address - Country:US
Mailing Address - Phone:810-208-6006
Mailing Address - Fax:810-208-6007
Practice Address - Street 1:14304 N FENTON RD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1544
Practice Address - Country:US
Practice Address - Phone:810-208-6006
Practice Address - Fax:810-208-6007
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor