Provider Demographics
NPI:1134327158
Name:JONES, ERIN MELISSA (OD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MELISSA
Last Name:JONES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 HIRAM DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-7267
Mailing Address - Country:US
Mailing Address - Phone:404-323-0176
Mailing Address - Fax:
Practice Address - Street 1:1681 OLD PENDERGRASS RD
Practice Address - Street 2:SUITE 170
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2718
Practice Address - Country:US
Practice Address - Phone:706-387-0111
Practice Address - Fax:706-366-1290
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002389152W00000X
SC1480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1134327158Medicaid
GA1134327158Medicaid