Basic Information
| Provider Information | |||||||||
| NPI: | 1619177086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 E METRO DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392324402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019923288 | ||||||||
| FaxNumber: | 6019923188 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 E METRO DR | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | FLOWOOD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 392324402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6019923288 | ||||||||
| FaxNumber: | 6019923188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2007 | ||||||||
| LastUpdateDate: | 09/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | T-1806 | MS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 753068151002 | 01 | TRICARE | OTHER | 753068151 | 01 | MHP | OTHER | 753068151 | 01 | 1ST CHOICE | OTHER | 02357749 | 05 | MS | MEDICAID | 7607991 | 01 | AETNA | OTHER | 753068151 | 01 | MPCN | OTHER | 168390709 | 01 | DOL | OTHER | 753068151 | 01 | UHC | OTHER |