Provider Demographics
NPI:1538670856
Name:JONES, TIMOTHY DEMETRIUS
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:DEMETRIUS
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2082 WINSBURG DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5224
Mailing Address - Country:US
Mailing Address - Phone:205-492-9285
Mailing Address - Fax:
Practice Address - Street 1:301 GOLD CREEK TRL
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-5404
Practice Address - Country:US
Practice Address - Phone:770-591-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO09886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor