Healthcare Provider Details

I. General information

NPI: 1083030613
Provider Name (Legal Business Name): JEWEL JONES FAISON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 W BROAD AVE BOX 71963 (31708)
ALBANY GA
31707-4393
US

IV. Provider business mailing address

1106 GREENWOOD DR
ALBANY GA
31707-3314
US

V. Phone/Fax

Practice location:
  • Phone: 229-869-3116
  • Fax:
Mailing address:
  • Phone: 229-869-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number052632410
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 6
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number213224
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: