Provider Demographics
NPI:1679557060
Name:RICE, JASMINA M (MD)
Entity Type:Individual
Prefix:
First Name:JASMINA
Middle Name:M
Last Name:RICE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JASMINIA
Other - Middle Name:M
Other - Last Name:WARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:189 JEFFERSON PKWY
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-5823
Mailing Address - Country:US
Mailing Address - Phone:770-304-2220
Mailing Address - Fax:770-304-2622
Practice Address - Street 1:189 JEFFERSON PKWY
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-5823
Practice Address - Country:US
Practice Address - Phone:770-304-2220
Practice Address - Fax:770-304-2622
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029555208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000357354DMedicaid