Provider Demographics
NPI:1689015711
Name:JONES, GEORGE MILLER
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:MILLER
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9930 59TH AVE
Mailing Address - Street 2:APT 3J
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-3860
Mailing Address - Country:US
Mailing Address - Phone:718-253-1366
Mailing Address - Fax:718-253-5890
Practice Address - Street 1:9930 59TH AVE
Practice Address - Street 2:APT 3J
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-3860
Practice Address - Country:US
Practice Address - Phone:718-253-1366
Practice Address - Fax:718-253-5890
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health