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General NPI Number Information
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NPI Number | 1508564709
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Entity Type | Individual
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Provider Name | JASMINE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 3136 GOLF RIDGE BLVD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1952
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Country | US
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Telephone | 877-288-4760
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Fax |
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Provider Business Mailing Address
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Address Line | 4680 LINDSEY DR
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-3414
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Country | US
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Telephone | 470-213-9730
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-22-4120
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License Number State | GA
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