Provider Demographics
NPI:1609501444
Name:MITCHELL, JASMINE (LMT)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 NATCHEZ TRL
Mailing Address - Street 2:
Mailing Address - City:CONLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30288-1323
Mailing Address - Country:US
Mailing Address - Phone:678-663-3264
Mailing Address - Fax:
Practice Address - Street 1:1115 MOUNT ZION RD
Practice Address - Street 2:SUITE A2, UNIT 1
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260
Practice Address - Country:US
Practice Address - Phone:470-444-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT011639225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist