Provider Demographics
NPI:1376566893
Name:MASHBURN, JANE (CNM)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:MASHBURN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2388 SANFORD RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5529
Mailing Address - Country:US
Mailing Address - Phone:404-634-8672
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST
Practice Address - Street 2:9TH FLOOR MOT
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308
Practice Address - Country:US
Practice Address - Phone:404-778-3401
Practice Address - Fax:404-686-4476
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR053661207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS89452002Medicare UPIN