Healthcare Provider Details

I. General information

NPI: 1457013997
Provider Name (Legal Business Name): JASMINE LOUIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 PHOENIX BLVD STE 100
ATLANTA GA
30349-5534
US

IV. Provider business mailing address

4671 CRESTED BUTTE RD
AUGUSTA GA
30909-9144
US

V. Phone/Fax

Practice location:
  • Phone: 404-823-3514
  • Fax:
Mailing address:
  • Phone: 803-466-5539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1449618
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMSW009385
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: