MEDICARE: JASMINE WEAVER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1356895478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE WEAVER

Provider Business Mailing Address
First Line	:	1426 CUPOLA PL
Second Line	:	APT 2813
City	:	COLUMBUS
State	:	GA
Zip	:	31903-2213
Country	:	US
Telephone Number	:	706-325-7543
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 CUPOLA PL
Second Line	:	APT 2813
City	:	COLUMBUS
State	:	GA
Zip	:	31903-2213
Country	:	US
Telephone Number	:	706-325-7543
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2016
Last Update Date	:	08/05/2016

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Directions to “ JASMINE WEAVER ” Practice Location

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