Provider Demographics
NPI:1619075884
Name:JONES, RONALD EUGENE (PA-C)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:EUGENE
Last Name:JONES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615A PENDLETON ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-4724
Mailing Address - Country:US
Mailing Address - Phone:912-548-0710
Mailing Address - Fax:912-283-8204
Practice Address - Street 1:615A PENDLETON ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-4724
Practice Address - Country:US
Practice Address - Phone:912-548-0710
Practice Address - Fax:912-283-8204
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003251363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003251OtherSTATE LICENSE
GA00001236AMedicaid
GA97BBDNZMedicare ID - Type UnspecifiedMEDICARE#
GAS73800Medicare UPIN