Healthcare Provider Details

I. General information

NPI: 1942146303
Provider Name (Legal Business Name): ASMIDE FLORENTINE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6385 MCGINNIS FERRY RD STE 202
JOHNS CREEK GA
30005-3672
US

IV. Provider business mailing address

923 PACES COMMONS DR
DULUTH GA
30096-1720
US

V. Phone/Fax

Practice location:
  • Phone: 470-508-9575
  • Fax:
Mailing address:
  • Phone: 917-564-4076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: