Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY002625 | GA |
Y | 103TC0700X | Clinical Psychologist | PSY002625 | GA |
N | 103TH0004X | Health Psychologist | PSY002625 | GA |
NPI | 1225192479 |
---|---|
Provider Name | Dr. Robert Tyre Jones IV |
First Address | Conyers, GA 30012-3882 |
Second Address | Conyers, GA 30012-3882 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 18/09/2007 |