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General NPI Number Information
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NPI Number | 1457974545
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Entity Type | Individual
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Provider Name | JAZMIN SHANEE BARNES
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Gender | Female
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Dates
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Enumeration Date | 05/22/2020
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 2696 MADISON MAE LN
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City | GRAYSON
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State | GA
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Zip | 30017-7819
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Country | US
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Telephone | 770-369-3429
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Fax |
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Provider Business Mailing Address
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Address Line | 2696 MADISON MAE LN
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City | GRAYSON
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State | GA
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Zip | 30017-7819
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Country | US
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Telephone |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | PCET003073
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP011594
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License Number State | GA
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