1154642569 NPI number — DR. MARRESA DECEMBER JONES D.C.

Table of content: DR. MARRESA DECEMBER JONES D.C. (NPI 1154642569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154642569 NPI number — DR. MARRESA DECEMBER JONES D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
MARRESA
Provider Middle Name:
DECEMBER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154642569
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
511 COLUMNS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITHIA SPRINGS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30122-3133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-641-3817
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
335 UPPER RIVERDALE RD
Provider Second Line Business Practice Location Address:
SUITE A8
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30236-1099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-629-1552
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2010

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: 111N00000X , with the licence number:  31498 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008901 . This is a "LICENSE NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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