Provider Demographics
NPI:1679536866
Name:JONES, KENNETH EARL (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:EARL
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 405611
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5611
Mailing Address - Country:US
Mailing Address - Phone:540-382-6148
Mailing Address - Fax:540-382-4191
Practice Address - Street 1:6 HICKOK ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3524
Practice Address - Country:US
Practice Address - Phone:540-382-6148
Practice Address - Fax:540-382-4191
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1515558OtherUMWA PROVIDER NUMBER
VA237816OtherMAMSI PROVIDER NUMBER
VA1679536866Medicaid
VA76828OtherSOUTHERN HEALTH PROVIDER
VA005624291Medicaid
VA080159224OtherMEDICARE RAILROAD
VATN0101OtherJOHN DEERE PROVIDER
VA1733327OtherUNITED HEALTHCARE
VA4218482OtherAETNA PROVIDER NUMBER
VA700010854OtherCIGNA PROVIDER NUMBER
VA1679536866Medicaid