Provider Demographics
NPI:1053467308
Name:JONES, TANYA YVONNE (MD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:YVONNE
Last Name:JONES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-2017
Mailing Address - Country:US
Mailing Address - Phone:478-864-3448
Mailing Address - Fax:478-864-1288
Practice Address - Street 1:116 SMITH ST
Practice Address - Street 2:
Practice Address - City:TENNILLE
Practice Address - State:GA
Practice Address - Zip Code:31089-1465
Practice Address - Country:US
Practice Address - Phone:478-552-1620
Practice Address - Fax:478-864-1288
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA028017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA28017OtherMEDICAL LICENSE