Provider Demographics
NPI:1134135023
Name:JONES, JAMES DAVID (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 GREEN ST NW STE 209A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3356
Mailing Address - Country:US
Mailing Address - Phone:770-503-7778
Mailing Address - Fax:770-995-1959
Practice Address - Street 1:311 GREEN ST NW STE 209A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3356
Practice Address - Country:US
Practice Address - Phone:770-503-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001623103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000458158AMedicaid
GA5202528503OtherBCBS - GA PROVIDER NUMBER
GA68BBCDGMedicare ID - Type UnspecifiedIND. PROVIDER NUMBER