Provider Demographics
NPI:1225192479
Name:JONES, ROBERT TYRE IV (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TYRE
Last Name:JONES
Suffix:IV
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1397 MANCHESTER DR NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3882
Mailing Address - Country:US
Mailing Address - Phone:770-483-6377
Mailing Address - Fax:770-929-0902
Practice Address - Street 1:1397 MANCHESTER DR NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3882
Practice Address - Country:US
Practice Address - Phone:770-483-6377
Practice Address - Fax:770-929-0902
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002625103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth