Provider Demographics
NPI:1811966849
Name:JONES, STEPHEN BRUCE (PAC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:BRUCE
Last Name:JONES
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566
Mailing Address - Country:US
Mailing Address - Phone:843-249-2868
Mailing Address - Fax:
Practice Address - Street 1:9869 OCEAN HWY W STE 12
Practice Address - Street 2:
Practice Address - City:CAROLINA SHORES
Practice Address - State:NC
Practice Address - Zip Code:28467-2636
Practice Address - Country:US
Practice Address - Phone:910-754-8600
Practice Address - Fax:910-755-2364
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant