MEDICARE: MICHAEL ALLEN JONES PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA003071	GA

General Provider Information

NPI Number	:	1689067753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ALLEN JONES PTA

Provider Business Mailing Address
First Line	:	205 WINDING RIVER DR UNIT H
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-1915
Country	:	US
Telephone Number	:	404-513-0340
Fax Number	:

Provider Business Practice Location Address
First Line	:	8480 ROSWELL RD
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-2800
Country	:	US
Telephone Number	:	404-513-0340
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2015
Last Update Date	:	03/12/2015

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