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NPI Code Detail

MEDICARE: JAZMINE PATTON APC, NCC, CCMHC

MEDICARE: JAZMINE PATTON APC, NCC, CCMHC
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 CounselorAPC006609GA

General Provider Information

NPI Number : 1710546809
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAZMINE PATTON APC, NCC, CCMHC
Provider Business Mailing Address
First Line : 4960 TERRACE GREEN TRCE
Second Line :
City : STONE MOUNTAIN
State : GA
Zip : 30088-3746
Country : US
Telephone Number : 203-444-6206
Fax Number :
Provider Business Practice Location Address
First Line : 4045 ORCHARD RD SE STE 110
Second Line :
City : SMYRNA
State : GA
Zip : 30080-4904
Country : US
Telephone Number : 770-293-1953
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2019
Last Update Date : 06/11/2019

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