Provider Demographics
NPI:1730249954
Name:JONES, ANISSA MONIQUE (DC)
Entity type:Individual
Prefix:DR
First Name:ANISSA
Middle Name:MONIQUE
Last Name:JONES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6581
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-6581
Mailing Address - Country:US
Mailing Address - Phone:478-746-7246
Mailing Address - Fax:147-874-7241
Practice Address - Street 1:419 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3320
Practice Address - Country:US
Practice Address - Phone:478-746-7246
Practice Address - Fax:478-746-7241
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU90825Medicare UPIN
35ZCGWTMedicare ID - Type Unspecified