Provider Demographics
NPI:1801851506
Name:JONES, BEVERLY NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:NICHOLAS
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 MAPLEWOOD AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3906
Mailing Address - Country:US
Mailing Address - Phone:336-659-8817
Mailing Address - Fax:336-659-7799
Practice Address - Street 1:3111 MAPLEWOOD AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3906
Practice Address - Country:US
Practice Address - Phone:336-659-8817
Practice Address - Fax:336-659-7799
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC93-001682084P0805X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8946779Medicaid
NCE53745Medicare UPIN
NC2192071EMedicare ID - Type Unspecified
NC8946779Medicaid