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General NPI Number Information
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NPI Number | 1326879420
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Entity Type | Individual
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Provider Name | JASMINE ELIZABETH ROSE HAGEN
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Gender | Female
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Dates
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Enumeration Date | 08/10/2024
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 1708 NORMAN DR
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City | VALDOSTA
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State | GA
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Zip | 31601-3574
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Country | US
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Telephone | 229-588-8017
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Fax |
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Provider Business Mailing Address
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Address Line | 590 LANIER AVE W
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1504
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Country | US
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Telephone | 678-688-9685
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Fax | 770-626-3791
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 13016
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License Number State | GA
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