Healthcare Provider Details

I. General information

NPI: 1952602823
Provider Name (Legal Business Name): JASMINE NAHEED, MDPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2010
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL DR SUITE 705
LAGRANGE GA
30240-4130
US

IV. Provider business mailing address

300 MEDICAL DR SUITE 705
LAGRANGE GA
30240-4130
US

V. Phone/Fax

Practice location:
  • Phone: 706-885-0111
  • Fax: 706-885-0607
Mailing address:
  • Phone: 706-885-0111
  • Fax: 706-885-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number056339
License Number StateGA

VIII. Authorized Official

Name: DR. JASMINE NAHEED
Title or Position: OWNER/PSYCHIATRIST
Credential: M.D.
Phone: 706-885-0111