Provider Demographics
NPI:1023122900
Name:JONES, ANGELA C (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:C
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 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-795-0659
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:1407 S MAIN ST
Practice Address - Street 2:
Practice Address - City:POPLARVILLE
Practice Address - State:MS
Practice Address - Zip Code:39470-3369
Practice Address - Country:US
Practice Address - Phone:601-795-0659
Practice Address - Fax:601-795-8639
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18351207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01959867Medicaid
MS640507572ZYOtherAMERICAN ADMIN GROUP
LA1782262Medicaid
MSP00424671OtherRAILROAD MEDICARE
MSP00424671OtherRAILROAD MEDICARE
MS01959867Medicaid