Provider Demographics
NPI:1629478474
Name:JONES, JAMES KENNETH (AA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KENNETH
Last Name:JONES
Suffix:
Gender:M
Credentials:AA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4720
Mailing Address - Country:US
Mailing Address - Phone:912-264-0014
Mailing Address - Fax:912-264-5003
Practice Address - Street 1:2301 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4720
Practice Address - Country:US
Practice Address - Phone:912-264-0014
Practice Address - Fax:912-264-5003
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant