Healthcare Provider Details

I. General information

NPI: 1912584608
Provider Name (Legal Business Name): JASBIR KAUR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COLLIER RD NW STE 2000
ATLANTA GA
30309-1734
US

IV. Provider business mailing address

10305 WOOD ACRES RD SW
OAKWOOD GA
30566-0332
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-1122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number99402
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: