Provider Demographics
NPI:1235750555
Name:JAEN DE JONES, GRETA ESTELA (LMT,MLD-C)
Entity Type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:ESTELA
Last Name:JAEN DE JONES
Suffix:
Gender:F
Credentials:LMT,MLD-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 SILVERLEAF WAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3718
Mailing Address - Country:US
Mailing Address - Phone:404-660-6703
Mailing Address - Fax:
Practice Address - Street 1:6710 JAMESTOWN DR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3030
Practice Address - Country:US
Practice Address - Phone:770-558-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012685225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist