Provider Demographics
NPI:1740345214
Name:JONES, MARVIN PAUL (MD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:PAUL
Last Name:JONES
Suffix:
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 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6004
Mailing Address - Fax:
Practice Address - Street 1:1375 EAST KING AVE
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548
Practice Address - Country:US
Practice Address - Phone:912-882-2910
Practice Address - Fax:912-882-9303
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029692174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00347278BMedicaid
GA11BDCFHMedicare ID - Type Unspecified
GAE19924Medicare UPIN
GAE19924Medicare UPIN