Provider Demographics
NPI:1801676119
Name:JONES, TIFFANY MONET (OD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MONET
Last Name:JONES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5115 GABLE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8607
Mailing Address - Country:US
Mailing Address - Phone:404-697-8969
Mailing Address - Fax:
Practice Address - Street 1:5115 GABLE RIDGE WAY
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-8607
Practice Address - Country:US
Practice Address - Phone:404-697-8969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6364152W00000X
GAOPT003574152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist