Provider Demographics
NPI:1750931085
Name:JONES, TANISHA (MSW)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-3624
Mailing Address - Country:US
Mailing Address - Phone:334-465-5443
Mailing Address - Fax:
Practice Address - Street 1:205 E 11TH ST
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-3624
Practice Address - Country:US
Practice Address - Phone:334-465-5443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor