Basic Information
| Provider Information | |||||||||
| NPI: | 1730147117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | TINA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3969 S COBB DR SE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300806358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704382942 | ||||||||
| FaxNumber: | 7704386560 | ||||||||
| Practice Location | |||||||||
| Address1: | 3969 S COBB DR SE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300806358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704382942 | ||||||||
| FaxNumber: | 7704386560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 03/28/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 029010 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00522112A | 05 | GA | MEDICAID | 58-1820883 | 01 | GA | HUMANA | OTHER | 7166299 | 01 | GA | CIGNA | OTHER | 318475 | 01 | GA | WELLCARE OF GEORGIA | OTHER | 4582404 | 01 | GA | AETNA | OTHER | 58-1820883 | 01 | GA | COVENTRY HEALTHCARE | OTHER |