Provider Demographics
NPI:1598496408
Name:EVANS, JASMINE M
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:M
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8171 MCKENZIE PL
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-5291
Mailing Address - Country:US
Mailing Address - Phone:843-318-2664
Mailing Address - Fax:
Practice Address - Street 1:2711 IRVIN WAY STE 201
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1724
Practice Address - Country:US
Practice Address - Phone:886-523-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-21
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician