MEDICARE: BEVERLY N JONES III MD PA

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	101YM0800X	Mental Health Counselor	2110	NC
2	2084P0805X	Geriatric Psychiatry Physician	93-00168	NC
3	2084P0800X	Psychiatry Physician	93-00168	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	017VJ	OTHER	NC	DR. JONES GROUP BCBS
2	20247	OTHER	NC	DR. JONES PARTNERS
3	137XC	OTHER	NC	ELIZABETH TOWNSEND BCBS
4	DB 3319-33	OTHER	NC	DR. JONES GROUP RR MEDICA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	46779	OTHER	NC	DR. JONES BCBS

General Provider Information

NPI Number	:	1972652469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEVERLY N JONES III MD PA

Provider Business Mailing Address
First Line	:	3111 MAPLEWOOD AVE
Second Line	:	SUITE 105
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3906
Country	:	US
Telephone Number	:	336-659-8817
Fax Number	:	336-659-7799

Provider Business Practice Location Address
First Line	:	3111 MAPLEWOOD AVE
Second Line	:	SUITE 105
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3906
Country	:	US
Telephone Number	:	336-659-8817
Fax Number	:	336-659-7799

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BEVERLY N JONES III
Credential	:	MD
Telephone Number	:	336-659-8817

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	10/05/2007

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1508857228 — HEARING CARE CENTER
Practice Location Address:

3111 MAPLEWOOD AVE , SUITE 107
WINSTON SALEM, NC
27103-3906

Practice Phone: 336-659-9569
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1801851506 — DR. BEVERLY NICHOLAS JONES MD
Practice Location Address:

3111 MAPLEWOOD AVE , SUITE 105
WINSTON SALEM, NC
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1750323705 — DR. BERT BENNETT III PH.D.
Practice Location Address:

3111 MAPLEWOOD AVE , SUITE 105
WINSTON-SALEM, NC
27103-3906

Practice Phone: 336-624-6412
Practice Fax: 336-724-3839

1356383251 — MS. ELIZABETH BENNETT TOWNSEND M.S.
Practice Location Address:

3111 MAPLEWOOD AVE , SUITE 105
WINSTON-SALEM, NC
27103-3906

Practice Phone: 336-659-8817
Practice Fax: 336-659-7799

1184719841 — NANCY B LONG LCSW
Practice Location Address:

3111 MAPLEWOOD AVE , SUITE 105
WINSTON SALEM, NC
27103-3906

Practice Phone: 336-659-8817
Practice Fax:

1285774166 — DR. J GRADY ELLIOTT O.D.
Practice Location Address:

3111 MAPLEWOOD AVE , SUITE 103
WINSTON SALEM, NC
27103-3906

Practice Phone: 336-765-8130
Practice Fax: 336-765-6403

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