Provider Demographics
NPI:1427636398
Name:JONES, JEWELL JUANA (AAS, TM, LMBT)
Entity type:Individual
Prefix:
First Name:JEWELL
Middle Name:JUANA
Last Name:JONES
Suffix:
Gender:F
Credentials:AAS, TM, LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 BROOKSTOWN AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2539
Mailing Address - Country:US
Mailing Address - Phone:336-701-0279
Mailing Address - Fax:
Practice Address - Street 1:1020 BROOKSTOWN AVE STE 9
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2539
Practice Address - Country:US
Practice Address - Phone:336-701-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11772225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist