Healthcare Provider Details

I. General information

NPI: 1073738506
Provider Name (Legal Business Name): JASMINE DENISE CARSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11638 HIGHWAY 27 STE 8
SUMMERVILLE GA
30747-8515
US

IV. Provider business mailing address

13570 N MAIN ST
TRENTON GA
30752-2012
US

V. Phone/Fax

Practice location:
  • Phone: 706-907-0932
  • Fax: 706-657-2958
Mailing address:
  • Phone: 706-907-0932
  • Fax: 706-657-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32953722
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: