Provider Demographics
NPI:1295989028
Name:JONES, MARLA AUTRY (CRNA)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:AUTRY
Last Name:JONES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JOYNER DR
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-5448
Mailing Address - Country:US
Mailing Address - Phone:706-647-7501
Mailing Address - Fax:
Practice Address - Street 1:3079 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:ANESTHESIA DEPT.
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2215
Practice Address - Country:US
Practice Address - Phone:800-945-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN072353367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I430699Medicare PIN