Provider Demographics
NPI:1497719595
Name:JONES, MARK MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MITCHELL
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 630
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1476
Mailing Address - Country:US
Mailing Address - Phone:404-355-3566
Mailing Address - Fax:404-355-3505
Practice Address - Street 1:2001 PEACHTREE RD NE
Practice Address - Street 2:SUITE 630
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1476
Practice Address - Country:US
Practice Address - Phone:404-355-3566
Practice Address - Fax:404-355-3505
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA030488208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E95534Medicare UPIN
GA24BCBVXMedicare PIN
GA24BCBCKMedicare PIN