Provider Demographics
NPI:1225408362
Name:PURIFY, JASON JAMAR (MSW, ST)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:JAMAR
Last Name:PURIFY
Suffix:
Gender:M
Credentials:MSW, ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 ROBERTS DR APT 4B
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2044
Mailing Address - Country:US
Mailing Address - Phone:678-547-0495
Mailing Address - Fax:678-547-0496
Practice Address - Street 1:9400 ROBERTS DR APT 4B
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2044
Practice Address - Country:US
Practice Address - Phone:678-547-0495
Practice Address - Fax:678-547-0496
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health