Healthcare Provider Details

I. General information

NPI: 1437924206
Provider Name (Legal Business Name): OCTAVIA JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2267 HASTINGS MANOR LN
HAMPTON GA
30228-6493
US

IV. Provider business mailing address

2267 HASTINGS MANOR LN
HAMPTON GA
30228-6493
US

V. Phone/Fax

Practice location:
  • Phone: 229-232-3831
  • Fax:
Mailing address:
  • Phone: 229-232-3831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN188497
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN188497
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN188497
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN188497
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: