Provider Demographics
NPI:1265763304
Name:JONAS, DEBORAH W (PA-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:W
Last Name:JONAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W MATTHEWS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1309
Mailing Address - Country:US
Mailing Address - Phone:704-708-4301
Mailing Address - Fax:704-708-4389
Practice Address - Street 1:211 W MATTHEWS ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1309
Practice Address - Country:US
Practice Address - Phone:704-708-4301
Practice Address - Fax:704-708-4389
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103424363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant