Provider Demographics
NPI:1992248173
Name:JONES, WALTER ELLIS III
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:ELLIS
Last Name:JONES
Suffix:III
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 1:107 COLONY PARK DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2787
Mailing Address - Country:US
Mailing Address - Phone:470-505-3576
Mailing Address - Fax:
Practice Address - Street 1:107 COLONY PARK DR
Practice Address - Street 2:SUITE 700
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2787
Practice Address - Country:US
Practice Address - Phone:470-505-3576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009174101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor