Provider Demographics
NPI:1427073899
Name:JONES, JEANINE L (DPM)
Entity type:Individual
Prefix:DR
First Name:JEANINE
Middle Name:L
Last Name:JONES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 MONTREAL RD
Mailing Address - Street 2:STE 316
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6924
Mailing Address - Country:US
Mailing Address - Phone:678-610-5988
Mailing Address - Fax:
Practice Address - Street 1:1430 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9111
Practice Address - Country:US
Practice Address - Phone:678-610-5988
Practice Address - Fax:678-610-5976
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001020213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV07579Medicare UPIN