Provider Demographics
NPI:1700070596
Name:JONES, JACK R JR (CO BOCO)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:R
Last Name:JONES
Suffix:JR
Gender:M
Credentials:CO BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DRIVE
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7254
Mailing Address - Country:US
Mailing Address - Phone:336-802-2400
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:611 N LINDSAY STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4318
Practice Address - Country:US
Practice Address - Phone:336-802-2250
Practice Address - Fax:336-802-2251
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC065257222Z00000X
NC222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795044Medicaid