Individual
JACOB JONES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
SPECIALIST SCH PSYCH
Contact information
Practice address
1979 LAKESIDE PKWY STE 800, TUCKER, GA 30084-5856
(800) 849-5502
Mailing address
1979 LAKESIDE PKWY STE 800, TUCKER, GA 30084-5856
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
SP0000000833225
MI
Other
Enumeration date
09/03/2013
Last updated
09/03/2013
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