MEDICARE: DR. CARLA BERNITA JONES LPN

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	164W00000X	Licensed Practical Nurse	LPN059388	GA
2	164X00000X	Licensed Vocational Nurse	LPN059388	GA
3	374K00000X	Religious Nonmedical Practitioner	LPN059388	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LPN059388	OTHER	GA	NURSING LICENSE

General Provider Information

NPI Number	:	1891032157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLA BERNITA JONES LPN

Provider Business Mailing Address
First Line	:	2064 RIDGEDALE RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317-1240
Country	:	US
Telephone Number	:	888-719-5445
Fax Number	:	678-805-4743

Provider Business Practice Location Address
First Line	:	2064 RIDGEDALE RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30317
Country	:	US
Telephone Number	:	888-719-5445
Fax Number	:	678-805-4743

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

Provider Enumeration Date	:	01/07/2013
Last Update Date	:	01/09/2013

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