Provider Demographics
NPI:1962066068
Name:JONES, MOLLIE M (PAC)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:ROSE
Other - Last Name:MICHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 440
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1797
Mailing Address - Country:US
Mailing Address - Phone:678-737-3799
Mailing Address - Fax:404-549-9803
Practice Address - Street 1:5673 PEACHTREE DUNWOODY RD STE 440
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1797
Practice Address - Country:US
Practice Address - Phone:678-737-3799
Practice Address - Fax:404-549-9803
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10459363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program