MEDICARE: MS. AYANA 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	1744P3200X	Prosthetics Case Management

General Provider Information

NPI Number	:	1538702832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AYANA JONES

Provider Business Mailing Address
First Line	:	6213 WINDSOR GATE LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-4262
Country	:	US
Telephone Number	:	917-586-8307
Fax Number	:

Provider Business Practice Location Address
First Line	:	9215 MONROE RD STE 4
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-2535
Country	:	US
Telephone Number	:	917-586-8307
Fax Number	:

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

Provider Enumeration Date	:	10/20/2019
Last Update Date	:	10/20/2019

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