Organization Name: | JASMINE PRIMM |
NPI Number: | 1033514609 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JASMINE PRIMM (PTA) |
Mailing Address: | 2810 Lawrenceville Hwy Tucker |
State: | GA US |
Postal Code: | 300846905 |
Phone Number: | 6784853605 |
Fax Number: | |
NPI Enumeration Date: | 10/25/2014 |
NPI Last Update Date: | 10/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | PTA003352 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |