Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 103K00000X | Behavior Analyst | ||
N | 104100000X | Social Worker | ||
N | 175F00000X | Naturopath |
NPI | 1104325653 |
---|---|
Provider Name | Dr. Keziah Jones |
First Address | Fairburn, GA 30213-8300 |
Second Address | Fairburn, GA 30213-8300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2018 |
Last Update Date | 09/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN227487 | NON PHYSICIAN PRACTIONER (01) | GA |