Basic Information
| Provider Information | |||||||||
| NPI: | 1194494039 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | GAIL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 GLENMORE DR | ||||||||
| Address2: | |||||||||
| City: | GUYTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313127526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054956269 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4451 COUNTRY CLUB RD | ||||||||
| Address2: | |||||||||
| City: | STATESBORO | ||||||||
| State: | GA | ||||||||
| PostalCode: | 304589233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9127642273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2021 | ||||||||
| LastUpdateDate: | 09/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN273117 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.