Provider Demographics
NPI:1912527359
Name:JONES, CARLIE R (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLIE
Middle Name:R
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 SOUTH MACON ST
Mailing Address - Street 2:B
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31545-1116
Mailing Address - Country:US
Mailing Address - Phone:912-294-5360
Mailing Address - Fax:
Practice Address - Street 1:163 E TOLLISON ST
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0120
Practice Address - Country:US
Practice Address - Phone:912-367-9841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty