Healthcare Provider Details

I. General information

NPI: 1003442484
Provider Name (Legal Business Name): ANGELIQUE JONES RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date: 01/31/2026
Reactivation Date: 07/20/2026

III. Provider practice location address

2385 LAWRENCEVILLE HWY
DECATUR GA
30033-3168
US

IV. Provider business mailing address

259 CHURCH ST
BRONWOOD GA
39826-3909
US

V. Phone/Fax

Practice location:
  • Phone: 404-289-4270
  • Fax:
Mailing address:
  • Phone: 229-310-1365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOTLP002893
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: