Provider Demographics
NPI:1669424487
Name:JONES, EDWARD JOHNSON III (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOHNSON
Last Name:JONES
Suffix:III
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:PO BOX 530062
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-0062
Mailing Address - Country:US
Mailing Address - Phone:843-695-6071
Mailing Address - Fax:843-569-5879
Practice Address - Street 1:115 EXECUTIVE PARKWAY
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461
Practice Address - Country:US
Practice Address - Phone:843-761-2815
Practice Address - Fax:843-869-8034
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22048208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT62189Medicaid
SC080157309OtherMEDICARE RAIL ROAD
SCAA59077126Medicaid
SCH22483Medicare UPIN
SCH224836834Medicare PIN
SCT62189Medicaid