MEDICARE: MR. JOHNNIE RAY JONES JR. RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	L003118	NC

General Provider Information

NPI Number	:	1578842068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHNNIE RAY JONES JR. RD

Provider Business Mailing Address
First Line	:	4580 ANTELOPE LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3183
Country	:	US
Telephone Number	:	828-226-4283
Fax Number	:

Provider Business Practice Location Address
First Line	:	4580 ANTELOPE LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-3183
Country	:	US
Telephone Number	:	828-226-4283
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2011
Last Update Date	:	08/15/2011

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