Provider Demographics
NPI:1669429460
Name:JERRY A. JONES, M.D., P.A.
Entity type:Organization
Organization Name:JERRY A. JONES, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-332-2272
Mailing Address - Street 1:700 S TORRENCE ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3077
Mailing Address - Country:US
Mailing Address - Phone:704-332-2272
Mailing Address - Fax:704-374-9201
Practice Address - Street 1:700 S TORRENCE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3077
Practice Address - Country:US
Practice Address - Phone:704-332-2272
Practice Address - Fax:704-374-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00-23388207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8947061Medicaid
NC8947061Medicaid
C84772Medicare UPIN
2309394Medicare ID - Type Unspecified