Provider Demographics
NPI:1164487021
Name:JONES, DONNA LEANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LEANN
Last Name:JONES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:DONNA
Other - Middle Name:LEANN
Other - Last Name:TYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:835 SUMMERCHASE TRL
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189
Mailing Address - Country:US
Mailing Address - Phone:770-928-7449
Mailing Address - Fax:
Practice Address - Street 1:1432 TOWNE LAKE PKWY STE 120
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8264
Practice Address - Country:US
Practice Address - Phone:770-928-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3999225100000X
GA3999225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7913Medicare PIN
GA511I650066Medicare PIN