Provider Demographics
NPI:1790364180
Name:JONES, DAVID A
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:JONES
Suffix:
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 1:116 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLANSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45332-9751
Mailing Address - Country:US
Mailing Address - Phone:937-670-4182
Mailing Address - Fax:
Practice Address - Street 1:116 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLLANSBURG
Practice Address - State:OH
Practice Address - Zip Code:45332-9751
Practice Address - Country:US
Practice Address - Phone:937-670-4182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker