Provider Demographics
NPI:1083030613
Name:FAISON, JEWEL JONES (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEWEL
Middle Name:JONES
Last Name:FAISON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3314
Mailing Address - Country:US
Mailing Address - Phone:229-869-3116
Mailing Address - Fax:
Practice Address - Street 1:1118 W BROAD AVE
Practice Address - Street 2:BOX 71963 (31708)
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-4393
Practice Address - Country:US
Practice Address - Phone:229-869-3116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 171W00000X, 172V00000X, 1744R1102X
GA052632410172A00000X
GA213224174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker
No1744R1102XOther Service ProvidersSpecialistResearch Study