Provider Demographics
NPI:1285065516
Name:ELIAS, JONATHAN AVERI (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:AVERI
Last Name:ELIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:A
Other - Last Name:ELIAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1609 CONSTITUTION BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3047
Mailing Address - Country:US
Mailing Address - Phone:803-366-8300
Mailing Address - Fax:803-327-4805
Practice Address - Street 1:1609 CONSTITUTION BLVD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3047
Practice Address - Country:US
Practice Address - Phone:803-366-8300
Practice Address - Fax:803-327-4805
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38115207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC381152Medicaid