MEDICARE: MS. JASMINE DENISE WILLIAMS MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW16485	FL
2	1041C0700X	Clinical Social Worker	CSW006426	GA

General Provider Information

NPI Number	:	1053741058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JASMINE DENISE WILLIAMS MSW

Provider Business Mailing Address
First Line	:	PO BOX 12427
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32317-2427
Country	:	US
Telephone Number	:	850-297-0114
Fax Number	:	850-297-0314

Provider Business Practice Location Address
First Line	:	2229 OAKLAND DOWNS WAY
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-3803
Country	:	US
Telephone Number	:	850-524-9069
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2013
Last Update Date	:	05/22/2023

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