Provider Demographics
NPI:1255594669
Name:FELECIAN D JONES MD PC
Entity type:Organization
Organization Name:FELECIAN D JONES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FELECIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-642-1362
Mailing Address - Street 1:24 VETERANS MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:LANETT
Mailing Address - State:AL
Mailing Address - Zip Code:36863-2840
Mailing Address - Country:US
Mailing Address - Phone:334-642-1362
Mailing Address - Fax:334-642-1364
Practice Address - Street 1:33 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:GRANTVILLE
Practice Address - State:GA
Practice Address - Zip Code:30220
Practice Address - Country:US
Practice Address - Phone:770-583-3382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6521Medicare PIN