Healthcare Provider Details

I. General information

NPI: 1497264329
Provider Name (Legal Business Name): STANLEY D. JONES, M.D.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 PEACHTREE ST
JESUP GA
31545-0245
US

IV. Provider business mailing address

391 PEACHTREE ST
JESUP GA
31545-0245
US

V. Phone/Fax

Practice location:
  • Phone: 912-530-7337
  • Fax: 912-530-7339
Mailing address:
  • Phone: 912-530-7337
  • Fax: 912-530-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number047607
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0008636459A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: DR. STANLEY D JONES
Title or Position: OWNER
Credential: M.D.
Phone: 912-530-7337