MEDICARE: MS. TERRICCA 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	3747P1801X	Personal Care Attendant	CN0030098017	GA

General Provider Information

NPI Number	:	1902618721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TERRICCA JONES

Provider Business Mailing Address
First Line	:	1700 NORTHSIDE DR NW # A73659
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-2673
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3191 DALE LN SW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30311-5316
Country	:	US
Telephone Number	:	678-358-1908
Fax Number	:

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

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	05/30/2025

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