Provider Demographics
NPI:1801987847
Name:JONES, MICHAEL WADE (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WADE
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 NATIONWIDE DR FL 2
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4272
Mailing Address - Country:US
Mailing Address - Phone:434-200-2500
Mailing Address - Fax:434-200-2501
Practice Address - Street 1:125 NATIONWIDE DR FL 2
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4272
Practice Address - Country:US
Practice Address - Phone:434-200-2500
Practice Address - Fax:434-200-2501
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02885207Q00000X
VA0102205019207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00467331OtherRR MEDICARE
KY000000514453OtherBCBS
KY64095250Medicaid
KYH55191Medicare UPIN
KY64095250Medicaid
KY0599603Medicare ID - Type Unspecified