Provider Demographics
NPI:1174195150
Name:JONES, JEFFERY PATRON
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:PATRON
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CAROLINE DR
Mailing Address - Street 2:
Mailing Address - City:MC INTYRE
Mailing Address - State:GA
Mailing Address - Zip Code:31054-2260
Mailing Address - Country:US
Mailing Address - Phone:478-595-2749
Mailing Address - Fax:
Practice Address - Street 1:2291 CLAXTON DAIRY RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4423
Practice Address - Country:US
Practice Address - Phone:478-595-1682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist