Provider Demographics
NPI:1801057427
Name:JONES, ANITA CAROLE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:CAROLE
Last Name:JONES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 THE PRADO
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-1361
Mailing Address - Country:US
Mailing Address - Phone:478-951-0078
Mailing Address - Fax:
Practice Address - Street 1:1508B HARDEMAN AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1471
Practice Address - Country:US
Practice Address - Phone:478-741-7337
Practice Address - Fax:478-741-7371
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN066948363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA94151OtherPEDIATRIC NURSING CERTIFICATION BOARD
GA00691567DMedicaid