Provider Demographics
NPI:1952400707
Name:JONES, HERBERT CORNELIUS (MD)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:CORNELIUS
Last Name:JONES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 MARTIN LUTHER KING JR DR SW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-1636
Mailing Address - Country:US
Mailing Address - Phone:404-691-7460
Mailing Address - Fax:404-691-7479
Practice Address - Street 1:2600 MARTIN LUTHER KING JR DR SW
Practice Address - Street 2:SUITE 204
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-1636
Practice Address - Country:US
Practice Address - Phone:404-691-7460
Practice Address - Fax:404-691-7479
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012173174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00016882CMedicaid
GA012173OtherLICENSE
GA581158044OtherTAX ID
GAD45792Medicare UPIN
GA1112173110AMedicare ID - Type Unspecified