Provider Demographics
NPI:1437924206
Name:JONES, OCTAVIA
Entity type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2267 HASTINGS MANOR LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6493
Mailing Address - Country:US
Mailing Address - Phone:229-232-3831
Mailing Address - Fax:
Practice Address - Street 1:2267 HASTINGS MANOR LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6493
Practice Address - Country:US
Practice Address - Phone:229-232-3831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188497163WG0600X, 163WP0809X, 163WH0200X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WC0400XNursing Service ProvidersRegistered NurseCase Management