MEDICARE: SUSAN LEIGH JONES MD LLC

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	320013	OTHER	GA	WELLCARE
3	52578011005	OTHER	GA	BLUE CROSS

General Provider Information

NPI Number	:	1427269455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN LEIGH JONES MD LLC

Provider Business Mailing Address
First Line	:	952 LAKE OCONEE PKWY
Second Line	:
City	:	EATONTON
State	:	GA
Zip	:	31024-5801
Country	:	US
Telephone Number	:	706-485-0880
Fax Number	:	706-485-0846

Provider Business Practice Location Address
First Line	:	952 LAKE OCONEE PKWY
Second Line	:
City	:	EATONTON
State	:	GA
Zip	:	31024-5801
Country	:	US
Telephone Number	:	706-485-0880
Fax Number	:	706-485-0846

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. SUSAN LEIGH JONES
Credential	:	MD
Telephone Number	:	706-485-0880

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/01/2010

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