Provider Demographics
NPI:1427269455
Name:SUSAN LEIGH JONES MD LLC
Entity type:Organization
Organization Name:SUSAN LEIGH JONES MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-485-0880
Mailing Address - Street 1:952 LAKE OCONEE PKWY
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-5801
Mailing Address - Country:US
Mailing Address - Phone:706-485-0880
Mailing Address - Fax:706-485-0846
Practice Address - Street 1:952 LAKE OCONEE PKWY
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-5801
Practice Address - Country:US
Practice Address - Phone:706-485-0880
Practice Address - Fax:706-485-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000398736CMedicaid
GA320013OtherWELLCARE
GA52578011005OtherBLUE CROSS
GA08BBRWFMedicare ID - Type UnspecifiedGRP # 7112
GA320013OtherWELLCARE