Provider Demographics
NPI:1750601464
Name:JONES, AUDREY K (DPT)
Entity type:Individual
Prefix:MS
First Name:AUDREY
Middle Name:K
Last Name:JONES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 TYE ST. SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316
Mailing Address - Country:US
Mailing Address - Phone:404-849-5666
Mailing Address - Fax:
Practice Address - Street 1:195 ARIZONA AVE.
Practice Address - Street 2:L/W-2, SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30307
Practice Address - Country:US
Practice Address - Phone:404-849-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0078582251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ22424Medicare PIN