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General NPI Number Information
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NPI Number | 1851917702
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Entity Type | Individual
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Provider Name | JASMINE BAILEY
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Gender | Female
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 2650 HIGHWAY 138 E
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City | JONESBORO
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State | GA
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Zip | 30236-2744
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Country | US
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Telephone | 770-473-4436
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Fax |
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Provider Business Mailing Address
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Address Line | 1040 EAGLE RDG
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City | ROSWELL
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State | GA
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Zip | 30076-1827
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT007667
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License Number State | GA
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