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General NPI Number Information
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NPI Number | 1992248173
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Entity Type | Individual
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Provider Name | MR. WALTER ELLIS JONES III
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Gender | Male
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Dates
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Enumeration Date | 11/21/2016
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Last Update Date | 11/21/2016
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Provider Practice Location Address
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Address Line | 107 COLONY PARK DR SUITE 700
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City | CUMMING
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State | GA
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Zip | 30040-2787
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Country | US
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Telephone | 470-505-3576
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Fax |
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Provider Business Mailing Address
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Address Line | 107 COLONY PARK DR SUITE 700
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City | CUMMING
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State | GA
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Zip | 30040-2787
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Country | US
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Telephone | 470-505-3576
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LPC009174
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License Number State | GA
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