Provider Demographics
NPI:1770666190
Name:JONES, EVAN (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 ASHLEY PHOSPHATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-8467
Mailing Address - Country:US
Mailing Address - Phone:843-552-8220
Mailing Address - Fax:843-552-8666
Practice Address - Street 1:3325 ASHLEY PHOSPHATE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-8467
Practice Address - Country:US
Practice Address - Phone:843-552-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6656207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC2154Medicaid
SCPC2154Medicaid
SCC60215Medicare UPIN