Provider Demographics
NPI:1841385168
Name:JONES FAMILY MEDICINE CLINIC PLLC
Entity Type:Organization
Organization Name:JONES FAMILY MEDICINE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAYE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-425-0092
Mailing Address - Street 1:30 CIRCLE J DR
Mailing Address - Street 2:STE 1
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1980
Mailing Address - Country:US
Mailing Address - Phone:601-425-0092
Mailing Address - Fax:601-425-0473
Practice Address - Street 1:30 CIRCLE J DR
Practice Address - Street 2:STE 1
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1980
Practice Address - Country:US
Practice Address - Phone:601-425-0092
Practice Address - Fax:601-425-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08706882Medicaid
MS08706882Medicaid