1467985275 NPI number — MRS. HEATHER NICOLE JONES NP

Table of content: MRS. HEATHER NICOLE JONES NP (NPI 1467985275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467985275 NPI number — MRS. HEATHER NICOLE JONES NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
HEATHER
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
HEATHER
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP-C
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1467985275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 89254
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30312-0254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-626-0600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5775 PEACHTREE DUNWOODY RD NE STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-1501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-634-2289
Provider Business Practice Location Address Fax Number:
844-257-4383
Provider Enumeration Date:
04/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  204513 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 003205675A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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