MEDICARE: DR. ERIC WONDERLY JONES D.M.D.

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	1223G0001X	General Practice Dentistry	8789	NC
2	1223G0001X	General Practice Dentistry	DN014285	GA

General Provider Information

NPI Number	:	1942436217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC WONDERLY JONES D.M.D.

Provider Business Mailing Address
First Line	:	7338 SPOUT SPRINGS RD
Second Line	:	SUITE C-15
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-5803
Country	:	US
Telephone Number	:	910-750-4277
Fax Number	:

Provider Business Practice Location Address
First Line	:	7338 SPOUT SPRINGS RD
Second Line	:	SUITE C-15
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-5803
Country	:	US
Telephone Number	:	910-750-4277
Fax Number	:

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

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	08/01/2011

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