Provider Demographics
NPI:1790359859
Name:TYSON, JASMINE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:A
Last Name:TYSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 ASBURY SQ
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-2404
Mailing Address - Country:US
Mailing Address - Phone:404-216-8986
Mailing Address - Fax:
Practice Address - Street 1:11555 MEDLOCK BRIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-3200
Practice Address - Country:US
Practice Address - Phone:678-263-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling