Healthcare Provider Details

I. General information

NPI: 1750222568
Provider Name (Legal Business Name): JASMINE IVIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LAKE HEARN DR NE APT 4524
BROOKHAVEN GA
30319-1867
US

IV. Provider business mailing address

1400 LAKE HEARN DR NE APT 4524
BROOKHAVEN GA
30319-1867
US

V. Phone/Fax

Practice location:
  • Phone: 615-509-2394
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number247532
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: