Basic Information
| Provider Information | |||||||||
| NPI: | 1679969141 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | NEKETHIA | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | JONES | ||||||||
| OtherFirstName: | NEKETHIA | ||||||||
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| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 303 N HILL PKWY | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303411252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789640275 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 175 GWINNETT DR | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300468444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782092394 | ||||||||
| FaxNumber: | 6782126343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2015 | ||||||||
| LastUpdateDate: | 04/12/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 243528 | GA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.