Provider Demographics
NPI:1831475482
Name:JONES, DEYANDA
Entity Type:Individual
Prefix:
First Name:DEYANDA
Middle Name:
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 1:3102 ABBEY DRIVE SOUTH WEST
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331
Mailing Address - Country:US
Mailing Address - Phone:706-627-6771
Mailing Address - Fax:
Practice Address - Street 1:3740 CASCADE ROAD SOUTH WEST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331
Practice Address - Country:US
Practice Address - Phone:404-472-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018921183500000X
SC8602183500000X
TN28203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist