Provider Demographics
NPI:1972652469
Name:BEVERLY N JONES III MD PA
Entity Type:Organization
Organization Name:BEVERLY N JONES III MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:N
Authorized Official - Last Name:JONES
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:336-659-8817
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2110101YM0800X
NC93-001682084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017VJOtherDR. JONES GROUP BCBS
NC20247OtherDR. JONES PARTNERS
NC137XCOtherELIZABETH TOWNSEND BCBS
NCDB 3319-33OtherDR. JONES GROUP RR MEDICA
NC6005875Medicaid
NC6103140Medicaid
NC46779OtherDR. JONES BCBS
NC2192071EMedicare ID - Type UnspecifiedDR. JONES
NC2337270Medicare ID - Type UnspecifiedGROUP NUMBER DR. JONES
NC137XCOtherELIZABETH TOWNSEND BCBS