MEDICARE: DR. RENEE JONES MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	01167	TN
2	2080A0000X	Pediatric Adolescent Medicine Physician	18191	MS
3	2080A0000X	Pediatric Adolescent Medicine Physician	E-8476	AR

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1700885522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENEE JONES MD

Provider Business Mailing Address
First Line	:	117 S 2ND ST
Second Line	:
City	:	AUGUSTA
State	:	AR
Zip	:	72006-2309
Country	:	US
Telephone Number	:	870-347-2534
Fax Number	:	870-347-3492

Provider Business Practice Location Address
First Line	:	615 N MAIN ST
Second Line	:
City	:	BRINKLEY
State	:	AR
Zip	:	72021-2507
Country	:	US
Telephone Number	:	870-734-1153
Fax Number	:	870-734-1179

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	09/06/2017

615 N MAIN STREET
BRINKLEY, AR
72021-2507

Practice Phone: 870-734-1150
Practice Fax: 978-327-7960