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General NPI Number Information
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NPI Number | 1811795958
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Entity Type | Individual
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Provider Name | JASMINE FULLER
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Gender | Female
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 2100 COMER AVE
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City | COLUMBUS
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State | GA
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Zip | 31904-8725
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Country | US
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Telephone | 706-596-5500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 370150
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City | DECATUR
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State | GA
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Zip | 30037-0150
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Country | US
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Telephone | 470-377-3517
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 978281
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | GAA-NP003412
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License Number State | GA
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