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General NPI Number Information
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NPI Number | 1255848636
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Entity Type | Individual
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Provider Name | BOBBY JONES
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Gender | Male
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Dates
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Enumeration Date | 01/06/2018
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Last Update Date | 01/06/2018
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Provider Practice Location Address
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Address Line | 2301 PARKWOOD DR STE 2
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City | BRUNSWICK
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State | GA
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Zip | 31520-4720
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Country | US
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Telephone | 912-342-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 PARKWOOD DR STE 2
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City | BRUNSWICK
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State | GA
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Zip | 31520-4720
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Country | US
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Telephone | 912-342-0060
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 003184
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License Number State | GA
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