Provider Demographics
NPI:1043222805
Name:JONES, HARLEY KEMP JR (OD)
Entity Type:Individual
Prefix:DR
First Name:HARLEY
Middle Name:KEMP
Last Name:JONES
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 FRENCH ST
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-5523
Mailing Address - Country:US
Mailing Address - Phone:706-551-9553
Mailing Address - Fax:
Practice Address - Street 1:803 FRENCH ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-5523
Practice Address - Country:US
Practice Address - Phone:706-551-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000136804EMedicaid
GA202I415756Medicare PIN
GAU05536Medicare UPIN
GA554946544SAMedicare PIN