Provider Demographics
NPI:1902004187
Name:JONES, LAUREN NATASHA (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:NATASHA
Last Name:JONES
Suffix:
Gender:F
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7810 PROVIDENCE RD
Practice Address - Street 2:STE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-2954
Practice Address - Country:US
Practice Address - Phone:704-543-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01240207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1902004187Medicaid
NC5907705Medicaid
SCNC2527Medicaid
NCNCF134AMedicare PIN
NC5907705Medicaid
NCNCF134EMedicare PIN
NCNCF134CMedicare PIN
NCNCF134BMedicare PIN
NC1902004187Medicaid
NCNCF134DMedicare PIN
NC2071741AMedicare UPIN