Provider Demographics
NPI:1457438129
Name:JONES, VICKIE DENESE (MD)
Entity Type:Individual
Prefix:DR
First Name:VICKIE
Middle Name:DENESE
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3097 LIONS CLUB LN;
Mailing Address - Street 2:
Mailing Address - City:LITHANIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038
Mailing Address - Country:US
Mailing Address - Phone:678-467-3006
Mailing Address - Fax:
Practice Address - Street 1:1918 NORTHLAKE PKWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-7070
Practice Address - Country:US
Practice Address - Phone:770-809-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044503208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000765542ABMedicaid