=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033119425
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. DEANNA CRAVEN JONES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2005
-----------------------------------------------------
Last Update Date | 09/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3940 ARROWHEAD BLVD STE 220
-----------------------------------------------------
City | MEBANE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27302-7637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-563-3007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3940 ARROWHEAD BLVD STE 220
-----------------------------------------------------
City | MEBANE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27302-7637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-563-3007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 25604
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------