Provider Demographics
NPI:1033662648
Name:JONES, DAVID BLAKE (LAC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BLAKE
Last Name:JONES
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 ARBOR GATES DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-5608
Mailing Address - Country:US
Mailing Address - Phone:404-784-7789
Mailing Address - Fax:
Practice Address - Street 1:165 W WIEUCA RD NE STE 209
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3252
Practice Address - Country:US
Practice Address - Phone:404-784-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-31
Last Update Date:2016-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA127171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist