Basic Information
| Provider Information | |||||||||
| NPI: | 1427644814 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JASMINE | ||||||||
| MiddleName: | SHERRELL | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 490411 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300490007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102744988 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2805 HAMILTON MILL RD | ||||||||
| Address2: | |||||||||
| City: | BUFORD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305194110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785410588 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2020 | ||||||||
| LastUpdateDate: | 12/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | TEMPAPRN0191 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 296176 | NC | N | Nursing Service Providers | Registered Nurse |
No ID Information.