Provider Demographics
NPI:1710204557
Name:JONES, CRISTINA (SLP)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:53 PERIMETER CENTER EAST
Mailing Address - Street 2:SUITE 550
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346
Mailing Address - Country:US
Mailing Address - Phone:770-822-9115
Mailing Address - Fax:770-822-9457
Practice Address - Street 1:4799 SUGARLOAF PKWY
Practice Address - Street 2:SUITE K
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044
Practice Address - Country:US
Practice Address - Phone:770-822-9115
Practice Address - Fax:770-822-9457
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007222235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT227802335OtherDRIVER'S LICENSE