MEDICARE: MISS JAZLYN BAIN LMSW

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	1041C0700X	Clinical Social Worker	CSW009556	GA

General Provider Information

NPI Number	:	1982302535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JAZLYN BAIN LMSW

Provider Business Mailing Address
First Line	:	2271 PLASTER RD NE APT 11
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30345-1147
Country	:	US
Telephone Number	:	470-847-8093
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 PIEDMONT RD NE STE 300
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-1512
Country	:	US
Telephone Number	:	404-351-2008
Fax Number	:

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

Provider Enumeration Date	:	02/22/2023
Last Update Date	:	01/07/2026

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