Provider Demographics
NPI:1154642569
Name:JONES, MARRESA DECEMBER (DC)
Entity Type:Individual
Prefix:DR
First Name:MARRESA
Middle Name:DECEMBER
Last Name:JONES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 COLUMNS DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-3133
Mailing Address - Country:US
Mailing Address - Phone:404-641-3817
Mailing Address - Fax:
Practice Address - Street 1:335 UPPER RIVERDALE RD
Practice Address - Street 2:SUITE A8
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1099
Practice Address - Country:US
Practice Address - Phone:770-629-1552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA008901OtherLICENSE NUMBER