Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT002048 | GA |
NPI | 1265523831 |
---|---|
Provider Name | Dr. Kenneth Allen Jones |
First Address | Smyrna, GA 30080-9318 |
Second Address | Atlanta, GA 30328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 26/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
283422181*21 | (05) | GA |
T79415 | (02) | GA |