Provider Demographics
NPI:1790758258
Name:JONES, GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
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 1:805 PAMPLICO HWY STE B300
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6081
Mailing Address - Country:US
Mailing Address - Phone:843-676-2760
Mailing Address - Fax:843-676-2762
Practice Address - Street 1:805 PAMPLICO HWY STE B300
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6081
Practice Address - Country:US
Practice Address - Phone:843-676-2760
Practice Address - Fax:843-676-2762
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13953208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC202935692047OtherBLUE CROSS ID NO.
SCTL5884Medicaid
SC202935692047OtherBLUE CROSS ID NO.
SCD18358Medicare UPIN