Healthcare Provider Details

I. General information

NPI: 1427644814
Provider Name (Legal Business Name): JASMINE SHERRELL WILLIAMS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 HAMILTON MILL RD
BUFORD GA
30519-4110
US

IV. Provider business mailing address

PO BOX 490411
LAWRENCEVILLE GA
30049-0007
US

V. Phone/Fax

Practice location:
  • Phone: 678-541-0588
  • Fax:
Mailing address:
  • Phone: 910-274-4988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number296176
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number296176
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTEMPAPRN0191
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: