Healthcare Provider Details

I. General information

NPI: 1871536235
Provider Name (Legal Business Name): MARK MCCLELLAN JONES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 JOHNSTON WILLIS DR SUITE A
NORTH CHESTERFIELD VA
23235-4765
US

IV. Provider business mailing address

1115 BOULDERS PKWY SUITE 200
NORTH CHESTERFIELD VA
23225-4067
US

V. Phone/Fax

Practice location:
  • Phone: 804-379-8088
  • Fax: 804-794-6067
Mailing address:
  • Phone: 804-560-5595
  • Fax: 804-560-9029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number101043848
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: