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General NPI Number Information
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NPI Number | 1407117344
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Entity Type | Organization
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Legal Business Name | THE JONES LEGACY GROUP, LLC
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Dates
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Enumeration Date | 06/07/2012
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Last Update Date | 06/07/2012
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Provider Practice Location Address
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Address Line | 3645 MARKETPLACE BLVD STE 130-361
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City | EAST POINT
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State | GA
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Zip | 30344-5747
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Country | US
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Telephone | 678-361-8017
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Fax |
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Provider Business Mailing Address
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Address Line | 3645 MARKETPLACE BLVD STE 130-361
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City | EAST POINT
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State | GA
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Zip | 30344-5747
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL OWNER
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Name | LAKIESHIA JONES
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Credential |
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Telephone | 678-361-8017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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