Provider Demographics
NPI:1013643469
Name:JONES, JASON TODD (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:TODD
Last Name:JONES
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5176 WHEELER DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-5215
Mailing Address - Country:US
Mailing Address - Phone:940-465-0367
Mailing Address - Fax:
Practice Address - Street 1:3966 S BOGAN RD STE C
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-8633
Practice Address - Country:US
Practice Address - Phone:678-765-8276
Practice Address - Fax:678-765-8274
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA624672084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry