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General NPI Number Information
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NPI Number | 1003699661
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Entity Type | Individual
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Provider Name | JASMAIN MACON FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/17/2023
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 6272 HICKORY LANE CIR
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City | UNION CITY
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State | GA
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Zip | 30291-5507
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Country | US
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Telephone | 803-920-5895
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Fax |
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Provider Business Mailing Address
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Address Line | 6272 HICKORY LANE CIR
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City | UNION CITY
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State | GA
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Zip | 30291-5507
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Country | US
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Telephone | 803-920-5895
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71015431A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2024030450
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 229320
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11033675
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15159700
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License Number State | NJ
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0036590
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License Number State | OH
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | GAA-NP001528
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License Number State | GA
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