Provider Demographics
NPI:1346305265
Name:JONES-JOHNSON, LOLITA
Entity type:Individual
Prefix:
First Name:LOLITA
Middle Name:
Last Name:JONES-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 GEORGE BUSBEE PKWY NW
Mailing Address - Street 2:724
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6823
Mailing Address - Country:US
Mailing Address - Phone:678-502-0341
Mailing Address - Fax:770-514-2803
Practice Address - Street 1:3355 GEORGE BUSBEE PKWY NW
Practice Address - Street 2:724
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6823
Practice Address - Country:US
Practice Address - Phone:678-502-0341
Practice Address - Fax:770-514-2803
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000734687EOtherPEACHSTATE PROVIDER #
GA10047949OtherAMERIGROUP
GA000734684EMedicaid