Provider Demographics
NPI:1467985275
Name:JONES, HEATHER NICOLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NICOLE
Last Name:JONES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 89254
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-0254
Mailing Address - Country:US
Mailing Address - Phone:404-626-0600
Mailing Address - Fax:
Practice Address - Street 1:5775 PEACHTREE DUNWOODY RD NE STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1501
Practice Address - Country:US
Practice Address - Phone:678-634-2289
Practice Address - Fax:844-257-4383
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA204513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003205675AMedicaid