Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 16553 | GA |
NPI | 1154795797 |
---|---|
Provider Name | James Jones |
First Address | Waynesboro, GA 30830 |
Second Address | Waynesboro, GA 30830-1404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2015 |
Last Update Date | 19/11/2015 |