Provider Demographics
NPI:1457791360
Name:JONES, SHONDA LENNETTE
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:LENNETTE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5631 HIGHWAY 42
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-3823
Mailing Address - Country:US
Mailing Address - Phone:770-364-1924
Mailing Address - Fax:
Practice Address - Street 1:5631 HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:ELLENWOOD
Practice Address - State:GA
Practice Address - Zip Code:30294-3823
Practice Address - Country:US
Practice Address - Phone:770-364-1924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist