Healthcare Provider Details

I. General information

NPI: 1265622633
Provider Name (Legal Business Name): JONES VISION ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CUMBERLAND MALL SE
ATLANTA GA
30339-8107
US

IV. Provider business mailing address

4495 REDAN CT
SMYRNA GA
30080-9318
US

V. Phone/Fax

Practice location:
  • Phone: 770-431-1713
  • Fax:
Mailing address:
  • Phone: 770-431-1713
  • Fax: 770-719-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002048
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KENNETH ALLEN JONES
Title or Position: OWNER
Credential: OD
Phone: 770-431-1713