Provider Demographics
NPI:1194762104
Name:JONES, CHRISTINA KEITH (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:KEITH
Last Name:JONES
Suffix:
Gender:F
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 746087
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6087
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:
Practice Address - Street 1:2721 BRONXWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3642
Practice Address - Country:US
Practice Address - Phone:718-765-6350
Practice Address - Fax:347-736-0207
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066919L207Q00000X, 207Q00000X
NY283160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04448380Medicaid
CA1194762104Medicaid
CAZZZ55168YOtherTRIWEST
CAZZZ55168YOtherTRIWEST
CA1194762104Medicaid
CABG850Medicare PIN
CE955ZMedicare PIN
CA1831365667Medicaid