MEDICARE: TIETRA G JONES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WL0100X	Lactation Consultant (Registered Nurse)	RN177295	GA

General Provider Information

NPI Number	:	1295084457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIETRA G JONES

Provider Business Mailing Address
First Line	:	5447 JAMERSON DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-6867
Country	:	US
Telephone Number	:	404-585-8227
Fax Number	:

Provider Business Practice Location Address
First Line	:	5447 JAMERSON DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-6867
Country	:	US
Telephone Number	:	404-585-8227
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2012
Last Update Date	:	08/12/2024

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