MEDICARE: DR. BEVERLY NICHOLAS JONES MD

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	2084P0805X	Geriatric Psychiatry Physician	93-00168	NC
2	2084P0800X	Psychiatry Physician	93-00168	NC

Other Identifiers

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

General Provider Information

NPI Number	:	1801851506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEVERLY NICHOLAS JONES MD

Provider Business Mailing Address
First Line	:	3111 MAPLEWOOD AVE
Second Line	:	SUITE 105
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3906
Country	:	US
Telephone Number	:	336-659-8817
Fax Number	:	336-659-7799

Provider Business Practice Location Address
First Line	:	3111 MAPLEWOOD AVE
Second Line	:	SUITE 105
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3906
Country	:	US
Telephone Number	:	336-659-8817
Fax Number	:	336-659-7799

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

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	03/16/2023

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