MEDICARE: SOUTHERN HERITAGE FINANCIAL GROUP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YP2500X	Professional Counselor
3	103TC1900X	Counseling Psychologist
4	103TF0000X	Family Psychologist
5	106H00000X	Marriage & Family Therapist
6	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1730026675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN HERITAGE FINANCIAL GROUP

Provider Business Mailing Address
First Line	:	6452 DEKEON DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8854
Country	:	US
Telephone Number	:	404-445-6258
Fax Number	:	404-381-2597

Provider Business Practice Location Address
First Line	:	6452 DEKEON DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8854
Country	:	US
Telephone Number	:	404-445-6258
Fax Number	:	404-381-2597

Authorized Official
Title or Position	:	MANAGING PRINCIPAL
Name	:	JASMINE SHANAY YOUNG
Credential	:	CPA
Telephone Number	:	404-445-6258

Provider Enumeration Date	:	04/29/2026
Last Update Date	:	04/29/2026

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