Provider Demographics
NPI:1033120407
Name:JONES, DONOVAN D JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:D
Last Name:JONES
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1027 BATEMAN DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-5025
Mailing Address - Country:US
Mailing Address - Phone:770-464-1900
Mailing Address - Fax:770-573-4337
Practice Address - Street 1:1027 BATEMAN DR
Practice Address - Street 2:SUITE C
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-5025
Practice Address - Country:US
Practice Address - Phone:770-464-1900
Practice Address - Fax:770-573-4337
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0085801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA01335500OtherUNITED CONCORDIA ID#