1548419203 NPI number — COURTNEY CRAWFORD JONES MD

Table of content: COURTNEY CRAWFORD JONES MD (NPI 1548419203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548419203 NPI number — COURTNEY CRAWFORD JONES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
COURTNEY
Provider Middle Name:
CRAWFORD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLORENZANO
Provider Other First Name:
COURTNEY
Provider Other Middle Name:
CRAWFORD
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548419203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 743070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-3070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-560-4304
Provider Business Mailing Address Fax Number:
864-560-4413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 E WOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29303-3040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-560-7025
Provider Business Practice Location Address Fax Number:
864-560-7388
Provider Enumeration Date:
09/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  35.094905 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 33387 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 333874 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01122406 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 439017 . This is a "UNITED HEALTH CARE/ UNISON" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: NPI # / SSN# . This is a "PREFERRED BLUE, STATE HEALTH PLAN, MEDICARE ADVANTAGE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 003111111A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30099060 . This is a "SELECT HEALTH-FIRST CHOICE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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