Provider Demographics
NPI:1700393626
Name:JONES, BOBBI LEE (BA, S/T)
Entity Type:Individual
Prefix:MRS
First Name:BOBBI
Middle Name:LEE
Last Name:JONES
Suffix:
Gender:F
Credentials:BA, S/T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 OAKDALE DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7910
Mailing Address - Country:US
Mailing Address - Phone:404-552-8500
Mailing Address - Fax:
Practice Address - Street 1:3330 CUMBERLAND BLVD SE STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5997
Practice Address - Country:US
Practice Address - Phone:687-638-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-30
Last Update Date:2017-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASTUDENT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health