1366624199 NPI number — THOMAS C JONES, M.D., P.C.

Table of content: (NPI 1366624199)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366624199 NPI number — THOMAS C JONES, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS C JONES, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE JONES CENTER FOR DIABETES & ENDOCRINE WELLNESS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366624199
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
265 SHERATON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31210-1359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-746-8626
Provider Business Mailing Address Fax Number:
478-746-0491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
265 SHERATON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31210-1359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-746-8626
Provider Business Practice Location Address Fax Number:
478-746-0491
Provider Enumeration Date:
12/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
478-746-8626

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  021530 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000201264A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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