Provider Demographics
NPI:1104482983
Name:JONES, BRIAN KENNETH (MED)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:KENNETH
Last Name:JONES
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 PEACHTREE PKWY STE 106
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7401
Mailing Address - Country:US
Mailing Address - Phone:678-771-8857
Mailing Address - Fax:678-771-8862
Practice Address - Street 1:564 PEACHTREE PKWY STE 106
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7401
Practice Address - Country:US
Practice Address - Phone:678-771-8857
Practice Address - Fax:678-771-8862
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003658237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter