Provider Demographics
NPI:1598819930
Name:JONES, SUSAN KATHERINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:KATHERINE
Last Name:JONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SKY
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1518 MONTE SANO AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-5323
Mailing Address - Country:US
Mailing Address - Phone:762-222-7040
Mailing Address - Fax:762-222-7032
Practice Address - Street 1:1518 MONTE SANO AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5323
Practice Address - Country:US
Practice Address - Phone:762-222-7040
Practice Address - Fax:762-222-7032
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0133391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA313255817FMedicaid