Basic Information
| Provider Information | |||||||||
| NPI: | 1487397253 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | ANTORIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1855 E DUBLIN GRANVILLE RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432293516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142677003 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4897 KARL RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432295147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148462588 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2022 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.