=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073411252
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BENJAMIN STEPHEN JONES
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2026
-----------------------------------------------------
Last Update Date | 10/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209 COOLEY DR # 203
-----------------------------------------------------
City | VILLA RICA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30180-7057
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-917-0826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 CHESTNUT ST
-----------------------------------------------------
City | BREMEN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30110-2101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-633-0865
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | PTA004494
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------