Healthcare Provider Details

I. General information

NPI: 1619717923
Provider Name (Legal Business Name): LYNN JONES COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2024
Last Update Date: 05/27/2024
Certification Date: 05/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 BROENING HWY STE 239
BALTIMORE MD
21224-6667
US

IV. Provider business mailing address

2200 BROENING HWY STE 239
BALTIMORE MD
21224-6667
US

V. Phone/Fax

Practice location:
  • Phone: 301-800-7641
  • Fax:
Mailing address:
  • Phone: 301-800-7641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MS. MONIQUE LYNNETTE JONES
Title or Position: CHIEF OPERATIONS MANAGER
Credential:
Phone: 301-800-7641