Provider Demographics
NPI:1700812773
Name:JONES, CYNTHIA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
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 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:
Practice Address - Street 1:1114 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7326
Practice Address - Country:US
Practice Address - Phone:843-212-8070
Practice Address - Fax:843-212-8071
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28735207Q00000X
GA056184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01157484OtherRR MEDICARE
SC287353Medicaid
SCP01157484OtherRR MEDICARE
SCAA66237522Medicare PIN
SCAA66237819Medicare PIN
GA373664224AMedicaid
SCAA66237006Medicare PIN
GAI37372Medicare UPIN
SCP01157484OtherRR MEDICARE
SCAA66236882Medicare PIN
SCAA66237126Medicare PIN
SCAA66235277Medicare PIN
SCAA66237498Medicare PIN
SCAA66235282Medicare PIN
SCAA66237499Medicare PIN
SCAA66236868Medicare PIN
SCAA66237555Medicare PIN
SCAA66238798Medicare PIN