MEDICARE: PAUL 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	1041C0700X	Clinical Social Worker	0904009250	VA

General Provider Information

NPI Number	:	1588868350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL JONES

Provider Business Mailing Address
First Line	:	101 W MUHAMMAD ALI BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12359 MANCHESTER WAY
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-5178
Country	:	US
Telephone Number	:	502-417-3072
Fax Number	:

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	01/22/2021

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