Healthcare Provider Details

I. General information

NPI: 1568037489
Provider Name (Legal Business Name): SHANE JONES DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12205 COUNTY LINE RD STE C
MADISON AL
35758-7720
US

IV. Provider business mailing address

12205 COUNTY LINE RD STE C
MADISON AL
35758-7720
US

V. Phone/Fax

Practice location:
  • Phone: 256-684-8247
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number402
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: