=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730164229
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BERNARD LEE JONES JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/07/2005
-----------------------------------------------------
Last Update Date | 10/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 S MORGAN AVE
-----------------------------------------------------
City | ANDREWS
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29510-2959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-264-5253
-----------------------------------------------------
Fax | 843-264-5970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1075 N FRASER ST GEORGETOWN HEALTH GROUP
-----------------------------------------------------
City | GEORGETOWN
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29440-2848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-527-4442
-----------------------------------------------------
Fax | 843-527-4027
-----------------------------------------------------
=====================================================
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 | 12648
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------