Provider Demographics
NPI:1417018920
Name:JONES, KENNETH E (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6325 SHANNON PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-1538
Mailing Address - Country:US
Mailing Address - Phone:770-964-1400
Mailing Address - Fax:770-306-1343
Practice Address - Street 1:6325 SHANNON PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-1538
Practice Address - Country:US
Practice Address - Phone:770-964-1400
Practice Address - Fax:678-815-1248
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA024000207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD32815Medicare UPIN