Provider Demographics
NPI:1407810781
Name:JONES, JESSE LEE (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JESSE
Other - Middle Name:L
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 88607
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30356-8607
Mailing Address - Country:US
Mailing Address - Phone:770-621-0870
Mailing Address - Fax:770-621-9518
Practice Address - Street 1:1370 MONTREAL RD
Practice Address - Street 2:SUITE 170
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-8128
Practice Address - Country:US
Practice Address - Phone:770-621-0870
Practice Address - Fax:770-621-9518
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035072207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00657544FMedicaid
GA00657544BMedicaid
GA00657544BMedicaid