MEDICARE: JERE K JONES

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	246Z00000X	Other Specialist/Technologist

General Provider Information

NPI Number	:	1790631968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERE K JONES

Provider Business Mailing Address
First Line	:	4401 SHALLOWFORD RD STE 166
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-3180
Country	:	US
Telephone Number	:	484-844-9776
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 SANDALWOOD DR
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-2333
Country	:	US
Telephone Number	:	484-844-9776
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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