Provider Demographics
NPI:1275711509
Name:MARY EMMA B JONES PHD PC
Entity Type:Organization
Organization Name:MARY EMMA B JONES PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY EMMA
Authorized Official - Middle Name:B
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-379-0909
Mailing Address - Street 1:PO BOX 881
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514-0881
Mailing Address - Country:US
Mailing Address - Phone:706-745-2872
Mailing Address - Fax:706-745-4644
Practice Address - Street 1:881 UPPER PLOTT TOWN ROAD
Practice Address - Street 2:
Practice Address - City:YOUNG HARRIS
Practice Address - State:GA
Practice Address - Zip Code:30582
Practice Address - Country:US
Practice Address - Phone:706-379-0909
Practice Address - Fax:706-379-0975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002217103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00791337AMedicaid
GA855189OtherBCBS
GA00791337AMedicaid