Healthcare Provider Details

I. General information

NPI: 1447866017
Provider Name (Legal Business Name): JAMAL JONES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2020
Last Update Date: 09/19/2020
Certification Date: 09/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NAPA VALLEY DR APT 1306
LITTLE ROCK AR
72211-5054
US

IV. Provider business mailing address

501 NAPA VALLEY DR APT 1306
LITTLE ROCK AR
72211-5054
US

V. Phone/Fax

Practice location:
  • Phone: 870-718-5779
  • Fax:
Mailing address:
  • Phone: 870-718-5779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRCP-4318
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: