Provider Demographics
NPI:1710576897
Name:JONES, ELIZABETH G
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:G
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 1:102 CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2263
Mailing Address - Country:US
Mailing Address - Phone:478-954-9242
Mailing Address - Fax:
Practice Address - Street 1:102 CLIFTON RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2263
Practice Address - Country:US
Practice Address - Phone:478-954-9242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist