=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467359810
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASMINE SIMONE SMITH CNM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2026
-----------------------------------------------------
Last Update Date | 10/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 290 COUNTRY CLUB DR
-----------------------------------------------------
City | STOCKBRIDGE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30281-9069
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-538-1723
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4144 SPENCER LN
-----------------------------------------------------
City | STONECREST
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30038-5515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | APRN-CNM277915
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------