1326034406 NPI number — CONNIE LOCKLEAR -JONES M.D.

Table of content: CONNIE LOCKLEAR -JONES M.D. (NPI 1326034406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326034406 NPI number — CONNIE LOCKLEAR -JONES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCKLEAR -JONES
Provider First Name:
CONNIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1326034406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 N ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUMBERTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28358-3011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-272-3051
Provider Business Mailing Address Fax Number:
910-738-3764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1345 NC HIGHWAY 268
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28645-9027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-754-6850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2005

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: 207Q00000X , with the licence number:  9501291 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 0095-01291 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8952738 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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