Provider Demographics
NPI:1922216068
Name:JONES, SANDRA BRYANT (PHARMD, CPH)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:BRYANT
Last Name:JONES
Suffix:
Gender:F
Credentials:PHARMD, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6645
Mailing Address - Country:US
Mailing Address - Phone:229-226-8700
Mailing Address - Fax:229-225-9649
Practice Address - Street 1:501 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6645
Practice Address - Country:US
Practice Address - Phone:229-226-8700
Practice Address - Fax:229-225-9649
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021628183500000X
FLPS37654183500000X
FLPU6207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003170641AOtherPEACHSTATE (MEDICAID)
GA003171233AMedicaid
GA202G878581OtherMEDICARE PART B
GA003171233AMedicaid