Provider Demographics
NPI:1902925183
Name:THE JONES CLINIC, LLC
Entity Type:Organization
Organization Name:THE JONES CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KECIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-754-1034
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:DEMOREST
Mailing Address - State:GA
Mailing Address - Zip Code:30535-0550
Mailing Address - Country:US
Mailing Address - Phone:706-754-1034
Mailing Address - Fax:706-754-1032
Practice Address - Street 1:207 ADAMS DR
Practice Address - Street 2:SUITE 2
Practice Address - City:DEMOREST
Practice Address - State:GA
Practice Address - Zip Code:30535-4501
Practice Address - Country:US
Practice Address - Phone:706-754-1034
Practice Address - Fax:706-754-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055247207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI56524Medicare UPIN
GA11SCGJSMedicare ID - Type Unspecified