MEDICARE: MS. SHELLIE ANN JONES RN

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	163W00000X	Registered Nurse	RN186747	GA

General Provider Information

NPI Number	:	1689860322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHELLIE ANN JONES RN

Provider Business Mailing Address
First Line	:	4125 CAMI WAY
Second Line	:
City	:	BUFORD
State	:	GA
Zip	:	30519-7432
Country	:	US
Telephone Number	:	678-546-5960
Fax Number	:

Provider Business Practice Location Address
First Line	:	175 GWINNETT DR
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-8444
Country	:	US
Telephone Number	:	678-209-2394
Fax Number	:	678-212-6343

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

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	11/10/2015

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