Provider Demographics
NPI:1851606743
Name:JONES, FREDRICK DWAYNE
Entity Type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:DWAYNE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ERIKA
Other - Middle Name:DENISE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6561
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39282-6561
Mailing Address - Country:US
Mailing Address - Phone:601-918-6415
Mailing Address - Fax:601-510-9850
Practice Address - Street 1:1003 DERYLL ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3924
Practice Address - Country:US
Practice Address - Phone:601-918-6415
Practice Address - Fax:601-510-9850
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)