Provider Demographics
NPI:1952080996
Name:JONES, EDWARD OLEARY
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:OLEARY
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-4349
Mailing Address - Country:US
Mailing Address - Phone:601-201-5701
Mailing Address - Fax:
Practice Address - Street 1:2608 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-4349
Practice Address - Country:US
Practice Address - Phone:601-201-5701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS800359589347C00000X
342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company
No347C00000XTransportation ServicesPrivate Vehicle