Provider Demographics
NPI:1619279106
Name:ERIN MELISSA JONES, PC
Entity Type:Organization
Organization Name:ERIN MELISSA JONES, PC
Other - Org Name:RENEWED VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-387-0111
Mailing Address - Street 1:1681 OLD PENDERGRASS RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-2718
Mailing Address - Country:US
Mailing Address - Phone:706-387-0111
Mailing Address - Fax:706-367-1290
Practice Address - Street 1:1681 OLD PENDERGRASS RD
Practice Address - Street 2:SUITE 170
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2718
Practice Address - Country:US
Practice Address - Phone:706-387-0111
Practice Address - Fax:706-367-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2389152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA642522523BMedicaid
GA202G707835Medicare PIN