Provider Demographics
NPI:1255848636
Name:JONES, BOBBY
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 PARKWOOD DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4720
Mailing Address - Country:US
Mailing Address - Phone:912-342-0060
Mailing Address - Fax:
Practice Address - Street 1:2301 PARKWOOD DR STE 2
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4720
Practice Address - Country:US
Practice Address - Phone:912-342-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-06
Last Update Date:2018-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003184225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist