Provider Demographics
NPI:1518950617
Name:JEFFERS, JASMINE GRACE (MD)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:GRACE
Last Name:JEFFERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3825 MEDICAL PARK DR
Mailing Address - Street 2:SUITE300
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1109
Mailing Address - Country:US
Mailing Address - Phone:770-941-4810
Mailing Address - Fax:770-948-9149
Practice Address - Street 1:3825 MEDICAL PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1109
Practice Address - Country:US
Practice Address - Phone:770-941-4810
Practice Address - Fax:770-948-9149
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA39136207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00616041JMedicaid
GAF70904Medicare UPIN
GA00616041JMedicaid