Provider Demographics
NPI:1386939163
Name:JONES, DOUGLAS WADE
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WADE
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 HIGHWAY 400 S
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6833
Mailing Address - Country:US
Mailing Address - Phone:706-216-2101
Mailing Address - Fax:706-216-2444
Practice Address - Street 1:51 HIGHWAY 400 S
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6833
Practice Address - Country:US
Practice Address - Phone:706-216-2101
Practice Address - Fax:706-216-2444
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA018499183500000X
ALP16046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist