Provider Demographics
NPI:1386318657
Name:JONES, WYATT (RBT)
Entity type:Individual
Prefix:
First Name:WYATT
Middle Name:
Last Name:JONES
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4143 COLUMBIA RD STE B
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-5405
Mailing Address - Country:US
Mailing Address - Phone:706-755-2785
Mailing Address - Fax:706-755-2783
Practice Address - Street 1:4143 COLUMBIA RD STE B
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5405
Practice Address - Country:US
Practice Address - Phone:706-755-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO702629106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician