Individual
DR. EDTH JONES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1244 CLAIRMONT RD STE 204, DECATUR, GA 30030-1263
(404) 274-4163
Mailing address
4380 E BROOKHAVEN DR NE, ATLANTA, GA 30319-1071
(404) 274-4163
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
004249
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004249
GEORGIA PROFESSIONAL LICENSING BOARD
GA
Enumeration date
11/06/2018
Last updated
11/06/2018
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