Provider Demographics
NPI:1699732073
Name:JONES, GARY C (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:C
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2459 EMERALD PL
Mailing Address - Street 2:STE 102
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5739
Mailing Address - Country:US
Mailing Address - Phone:252-695-0424
Mailing Address - Fax:252-695-2031
Practice Address - Street 1:1006D WH SMITH BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834
Practice Address - Country:US
Practice Address - Phone:252-695-0424
Practice Address - Fax:252-695-2031
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC47059OtherBCBS NC
NC5905990Medicaid
NC203986JMedicare PIN
NCC82202Medicare UPIN