Provider Demographics
NPI:1013542539
Name:JONES, KASHANNA R
Entity Type:Individual
Prefix:
First Name:KASHANNA
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 POINT PETER PL
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-2575
Mailing Address - Country:US
Mailing Address - Phone:912-409-7231
Mailing Address - Fax:
Practice Address - Street 1:334 POINT PETER PL
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-2575
Practice Address - Country:US
Practice Address - Phone:912-409-7231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer