MEDICARE: ELBERT R JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1508562521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELBERT R JONES

Provider Business Mailing Address
First Line	:	3624 KEY TURN ST
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-3940
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3624 KEY TURN ST
Second Line	:
City	:	DISTRICT HEIGHTS
State	:	MD
Zip	:	20747-3940
Country	:	US
Telephone Number	:	301-580-8289
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	02/01/2023

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Directions to “ ELBERT R JONES ” Practice Location

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