Provider Demographics
NPI:1245268937
Name:JONES, SAMUEL JR (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:JONES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123A HIGHWAY 80 E # 99
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4738
Mailing Address - Country:US
Mailing Address - Phone:601-924-7043
Mailing Address - Fax:601-924-4546
Practice Address - Street 1:102 WOODCHASE PARK DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4113
Practice Address - Country:US
Practice Address - Phone:601-924-7043
Practice Address - Fax:601-924-4546
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00012574Medicaid
MSD74329Medicare UPIN
MS00012574Medicaid
MS251850Medicare Oscar/Certification