Provider Demographics
NPI:1154530681
Name:JONES, GLYNN E SR
Entity type:Individual
Prefix:MR
First Name:GLYNN
Middle Name:E
Last Name:JONES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-4806
Mailing Address - Country:US
Mailing Address - Phone:601-922-8282
Mailing Address - Fax:601-922-8052
Practice Address - Street 1:4531 HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-4806
Practice Address - Country:US
Practice Address - Phone:601-922-8282
Practice Address - Fax:601-922-8052
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880219Medicaid