Healthcare Provider Details

I. General information

NPI: 1710964622
Provider Name (Legal Business Name): JOHN O JONES MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 POWELL LANE
FLATWOODS KY
41139-1614
US

IV. Provider business mailing address

1108 POWELL LANE
FLATWOODS KY
41139-1614
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-8086
  • Fax: 606-836-3743
Mailing address:
  • Phone: 606-836-8086
  • Fax: 606-836-3743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13008
License Number StateKY

VIII. Authorized Official

Name: JOHN O JONES
Title or Position: PHYSICIAN
Credential: MD
Phone: 606-836-8086