Provider Demographics
NPI:1083351019
Name:JONES, SHAVON L
Entity Type:Individual
Prefix:MS
First Name:SHAVON
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4762 LOST COLONY CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3522
Mailing Address - Country:US
Mailing Address - Phone:267-370-6972
Mailing Address - Fax:404-994-7006
Practice Address - Street 1:4762 LOST COLONY CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-3522
Practice Address - Country:US
Practice Address - Phone:267-370-6972
Practice Address - Fax:404-994-7006
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA225000000X, 1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA881612487OtherCRANIAL PROSTHESIS