Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 021408 | GA |
NPI | 1245223304 |
---|---|
Provider Name | David W Jones |
First Address | Stockbridge, GA 30281-9200 |
Second Address | Stockbridge, GA 30281-9200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 07/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000219128K | (05) | GA |
D45786 | (02) |