Healthcare Provider Details

I. General information

NPI: 1558802298
Provider Name (Legal Business Name): JORDAN TONOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 LOOP RD STE C
MCDONOUGH GA
30253-3144
US

IV. Provider business mailing address

110 SKIPJACK CT
COVINGTON GA
30016-9196
US

V. Phone/Fax

Practice location:
  • Phone: 321-557-8581
  • Fax:
Mailing address:
  • Phone: 321-557-8581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-22-13865
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: