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General NPI Number Information
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NPI Number | 1609241538
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Entity Type | Individual
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Provider Name | SAMUEL W JONES CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/03/2015
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 1968 PEACHTREE RD NW
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City | ATLANTA
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State | GA
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Zip | 30309-1281
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Country | US
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Telephone | 678-216-0771
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Fax |
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Provider Business Mailing Address
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Address Line | 10800 MIDLOTHIAN TPKE
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4724
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Country | US
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Telephone | 804-594-2622
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Fax | 804-594-0915
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001231147
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | C-APN.0003966-C-CRNA
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | GA-CRNA001081
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License Number State | GA
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