Healthcare Provider Details

I. General information

NPI: 1841704699
Provider Name (Legal Business Name): INGRAM-JONES AND ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10646 FORD AVE STE B
RICHMOND HILL GA
31324
US

IV. Provider business mailing address

299 MCGREGOR CIR
RICHMOND HILL GA
31324-9313
US

V. Phone/Fax

Practice location:
  • Phone: 912-445-2517
  • Fax:
Mailing address:
  • Phone: 912-445-2517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080C0008X
TaxonomyChild Abuse Pediatrics Physician
License NumberRN163089
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN163089
License Number StateGA

VIII. Authorized Official

Name: DR. TRINITY LYNN INGRAM-JONES
Title or Position: OWNER/OPERATOR/SOLE PROVIDER
Credential: DNP, CPNP, AFN-BC
Phone: 912-445-2517