Provider Demographics
NPI:1184789455
Name:JONES, DAWN LACHANDRA (OTRL)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LACHANDRA
Last Name:JONES
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:LACHANDRA
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2759 MOUNT ZION PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2568
Mailing Address - Country:US
Mailing Address - Phone:678-545-6745
Mailing Address - Fax:678-489-7065
Practice Address - Street 1:2759 MOUNT ZION PKWY STE A
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2568
Practice Address - Country:US
Practice Address - Phone:678-545-6745
Practice Address - Fax:678-489-7065
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003694225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA513798915FMedicaid
GA513798915BMedicaid