Provider Demographics
NPI:1184342826
Name:JONES, STEPHANIE ANTOINETTE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANTOINETTE
Last Name:JONES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4772 SHIRE DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2988
Mailing Address - Country:US
Mailing Address - Phone:470-865-1517
Mailing Address - Fax:
Practice Address - Street 1:4772 SHIRE DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2988
Practice Address - Country:US
Practice Address - Phone:470-865-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN177436163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse