Provider Demographics
NPI:1598933418
Name:JONES, MARY DENISE
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DENISE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:DENISE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2310 THE VLY NE
Mailing Address - Street 2:2310
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5414
Mailing Address - Country:US
Mailing Address - Phone:770-394-0677
Mailing Address - Fax:
Practice Address - Street 1:2920 PHARR COURT SOUTH NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2104
Practice Address - Country:US
Practice Address - Phone:404-261-9043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN070066164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse