Provider Demographics
NPI:1891032157
Name:JONES, CARLA BERNITA (LPN)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:BERNITA
Last Name:JONES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2064 RIDGEDALE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30317-1240
Mailing Address - Country:US
Mailing Address - Phone:888-719-5445
Mailing Address - Fax:678-805-4743
Practice Address - Street 1:2064 RIDGEDALE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317
Practice Address - Country:US
Practice Address - Phone:888-719-5445
Practice Address - Fax:678-805-4743
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN059388164W00000X, 164X00000X, 374K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPN059388OtherNURSING LICENSE