Provider Demographics
NPI:1760410146
Name:JONES, KECIA JACKSON (MD)
Entity Type:Individual
Prefix:DR
First Name:KECIA
Middle Name:JACKSON
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KECIA
Other - Middle Name:GRACE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 550
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535
Mailing Address - Country:US
Mailing Address - Phone:706-754-1034
Mailing Address - Fax:706-754-1032
Practice Address - Street 1:225 ADAMS DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535
Practice Address - Country:US
Practice Address - Phone:706-754-1034
Practice Address - Fax:706-754-1032
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055247207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA620650772AMedicaid
GA11SCGJSMedicare ID - Type Unspecified
GA620650772AMedicaid