Provider Demographics
NPI:1659974137
Name:JONES, BRENDA PATRICIA
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:PATRICIA
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 STONEYBROOKS PL # A
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-4242
Mailing Address - Country:US
Mailing Address - Phone:762-994-7115
Mailing Address - Fax:
Practice Address - Street 1:138 STONEYBROOKS PL # A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-4242
Practice Address - Country:US
Practice Address - Phone:762-994-7115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty