Healthcare Provider Details

I. General information

NPI: 1669429460
Provider Name (Legal Business Name): JERRY A. JONES, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S TORRENCE ST SUITE 110
CHARLOTTE NC
28204-3077
US

IV. Provider business mailing address

700 S TORRENCE ST SUITE 110
CHARLOTTE NC
28204-3077
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-2272
  • Fax: 704-374-9201
Mailing address:
  • Phone: 704-332-2272
  • Fax: 704-374-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number00-23388
License Number StateNC

VIII. Authorized Official

Name: DR. JERRY ANTHONY JONES
Title or Position: OWNER
Credential: MD
Phone: 704-332-2272