Provider Demographics
NPI:1205267804
Name:JONES, CHARMAGNE
Entity type:Individual
Prefix:
First Name:CHARMAGNE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 KELLER SPRINGS RD APT 1369
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-6530
Mailing Address - Country:US
Mailing Address - Phone:952-220-1369
Mailing Address - Fax:
Practice Address - Street 1:4800 KELLER SPRINGS RD APT 1369
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6530
Practice Address - Country:US
Practice Address - Phone:952-220-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health