Provider Demographics
NPI:1912620386
Name:JEANS, CYMONE
Entity Type:Individual
Prefix:
First Name:CYMONE
Middle Name:
Last Name:JEANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 LEGACY PARK DR APT 525
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8719
Mailing Address - Country:US
Mailing Address - Phone:901-361-0624
Mailing Address - Fax:
Practice Address - Street 1:316 W PIKE ST STE 202I
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4878
Practice Address - Country:US
Practice Address - Phone:678-568-6058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist