Provider Demographics
NPI:1922154483
Name:JONES, CAROL FULWILER (MA)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:FULWILER
Last Name:JONES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 HYDE MANOR DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1127
Mailing Address - Country:US
Mailing Address - Phone:404-352-3169
Mailing Address - Fax:404-367-0369
Practice Address - Street 1:2801 BUFORD HWY NE
Practice Address - Street 2:SUITE 225
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2149
Practice Address - Country:US
Practice Address - Phone:404-633-3041
Practice Address - Fax:404-367-0369
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC1181101YP2500X
GALMFT445106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist