Provider Demographics
NPI:1386941722
Name:JONAH, VIOLET OLUYINKA
Entity type:Individual
Prefix:
First Name:VIOLET
Middle Name:OLUYINKA
Last Name:JONAH
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 1:4110 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1803
Mailing Address - Country:US
Mailing Address - Phone:404-294-6504
Mailing Address - Fax:404-299-5820
Practice Address - Street 1:6402 GREENOCK DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6088
Practice Address - Country:US
Practice Address - Phone:770-469-8353
Practice Address - Fax:770-469-8353
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021545183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist