Provider Demographics
NPI:1699835900
Name:JONES, MARY EMMA BROWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY EMMA
Middle Name:BROWN
Last Name:JONES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:YOUNG HARRIS
Mailing Address - State:GA
Mailing Address - Zip Code:30582-0833
Mailing Address - Country:US
Mailing Address - Phone:706-379-0909
Mailing Address - Fax:706-379-0975
Practice Address - Street 1:881 UPPER PLOTT TOWN RD
Practice Address - Street 2:
Practice Address - City:YOUNG HARRIS
Practice Address - State:GA
Practice Address - Zip Code:30582-3894
Practice Address - Country:US
Practice Address - Phone:706-379-0909
Practice Address - Fax:706-379-0975
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002217103T00000X
GA2217103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52-2359464OtherTAX IDENTIFICATION NUMBER
GA00791337AMedicaid