Healthcare Provider Details

I. General information

NPI: 1023933777
Provider Name (Legal Business Name): DEMETRIST JONES RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 CONNER ST
DETROIT MI
48213-3405
US

IV. Provider business mailing address

12778 TURNER ST
DETROIT MI
48238-3152
US

V. Phone/Fax

Practice location:
  • Phone: 248-825-1579
  • Fax:
Mailing address:
  • Phone: 248-825-1579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number4401004317
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: