1346321650 NPI number — MR. CHRISTOPHER TODD JONES M.D.

Table of content: ANTHONY VICTOR GONZALEZ MHC-LP (NPI 1952188807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346321650 NPI number — MR. CHRISTOPHER TODD JONES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
CHRISTOPHER
Provider Middle Name:
TODD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1346321650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6035 FAIRVIEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28210-3256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-295-3000
Provider Business Mailing Address Fax Number:
704-295-3468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 SUTTON RD S STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT MILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29715-8439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-328-1864
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2006

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: 174400000X , with the licence number:  TL39407 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X , with the licence number: 29407 , 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: 294078 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1102138 . This is a "WELLCARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: NCE466A . This is a "MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: AA17665874 . This is a "MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1506259 . This is a "COVENTRY" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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