Provider Demographics
NPI:1801896212
Name:JONES, SUSAN LEIGH (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:LEIGH
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 LAKE OCONEE PKWY
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-5801
Mailing Address - Country:US
Mailing Address - Phone:706-485-0880
Mailing Address - Fax:706-485-0846
Practice Address - Street 1:952 LAKE OCONEE PKWY
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-5801
Practice Address - Country:US
Practice Address - Phone:706-485-0880
Practice Address - Fax:706-485-0846
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000398736CMedicaid
E81359Medicare UPIN
08BBRWFMedicare ID - Type Unspecified
GA000398736CMedicaid