Basic Information
Provider Information
NPI: 1174607964
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JONES
FirstName: JENNIFER
MiddleName: H
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3495 PIEDMONT RD NE
Address2: NINE PIEDMONT CENTER
City: ATLANTA
State: GA
PostalCode: 303051717
CountryCode: US
TelephoneNumber: 4043647000
FaxNumber:  
Practice Location
Address1: 20 GLENLAKE PKWY
Address2:  
City: ATLANTA
State: GA
PostalCode: 303283473
CountryCode: US
TelephoneNumber: 7706777370
FaxNumber: 7706777389
Other Information
ProviderEnumerationDate: 10/25/2006
LastUpdateDate: 01/13/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XCSW000788GAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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