Healthcare Provider Details

I. General information

NPI: 1689949554
Provider Name (Legal Business Name): JERREL ANDRE JONES DC, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 SCENIC HWY N STE Y
SNELLVILLE GA
30078-5685
US

IV. Provider business mailing address

1630 SCENIC HWY N STE Y
SNELLVILLE GA
30078-5685
US

V. Phone/Fax

Practice location:
  • Phone: 678-400-6711
  • Fax:
Mailing address:
  • Phone: 678-400-6711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR010561
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT006503
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT006503
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: