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NPI Code Detail

MEDICARE: JASMINE S MOON

MEDICARE: JASMINE S MOON
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
1101YM0800XMental Health Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619483674
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMINE S MOON
Provider Business Mailing Address
First Line : 1921 WHITTLESEY RD STE 400
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-9211
Country : US
Telephone Number : 706-571-7771
Fax Number :
Provider Business Practice Location Address
First Line : 1921 WHITTLESEY RD STE 400
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-9211
Country : US
Telephone Number : 706-571-7771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2017
Last Update Date : 04/27/2018

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Directions to “ JASMINE S MOON ” Practice Location

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