Provider Demographics
NPI:1316583644
Name:WASHINGTON, JAZMINE NICHOLE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JAZMINE
Middle Name:NICHOLE
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 DOROTHY DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-5426
Mailing Address - Country:US
Mailing Address - Phone:478-973-8903
Mailing Address - Fax:
Practice Address - Street 1:3960 DOROTHY DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-5426
Practice Address - Country:US
Practice Address - Phone:478-973-8903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0037662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer