Provider Demographics
NPI:1033514609
Name:JASMINE PRIMM
Entity Type:Organization
Organization Name:JASMINE PRIMM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-485-3605
Mailing Address - Street 1:2810 LAWRENCEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6905
Mailing Address - Country:US
Mailing Address - Phone:678-485-3605
Mailing Address - Fax:
Practice Address - Street 1:2810 LAWRENCEVILLE HWY
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6905
Practice Address - Country:US
Practice Address - Phone:678-485-3605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-25
Last Update Date:2014-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003352261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy