Provider Demographics
NPI:1831112622
Name:JONES, GEORGE RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:RICHARD
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 HOSPITAL DR STE 350
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-8011
Mailing Address - Country:US
Mailing Address - Phone:478-742-5255
Mailing Address - Fax:478-742-2339
Practice Address - Street 1:380 HOSPITAL DR STE 350
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-8011
Practice Address - Country:US
Practice Address - Phone:478-742-5255
Practice Address - Fax:478-742-2339
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00135363AMedicaid
GA00135363AMedicaid
GAD70476Medicare UPIN