Provider Demographics
NPI:1740825264
Name:JOHNNA JONES DO FACOS PA
Entity type:Organization
Organization Name:JOHNNA JONES DO FACOS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-237-6311
Mailing Address - Street 1:5204 LONG SHOT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76114-1253
Mailing Address - Country:US
Mailing Address - Phone:817-237-6311
Mailing Address - Fax:
Practice Address - Street 1:800 8TH AVE STE 116
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2606
Practice Address - Country:US
Practice Address - Phone:817-237-6311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114997186OtherNPI INDIVIDUAL