Provider Demographics
NPI:1053757328
Name:JONES, CHRISTOPHER DERRILL (HIS)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DERRILL
Last Name:JONES
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 ERNEST W BARRETT PKWY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-4918
Mailing Address - Country:US
Mailing Address - Phone:770-693-4509
Mailing Address - Fax:678-909-2888
Practice Address - Street 1:440 ERNEST W BARRETT PKWY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-4918
Practice Address - Country:US
Practice Address - Phone:770-693-4509
Practice Address - Fax:678-909-2888
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80397237700000X
GAHADS000902237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist