Provider Demographics
NPI:1821857509
Name:ANSLEY, JASMINE AMARI (LDO)
Entity Type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:AMARI
Last Name:ANSLEY
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2685 BURNSTONE RUN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5030
Mailing Address - Country:US
Mailing Address - Phone:678-779-0988
Mailing Address - Fax:
Practice Address - Street 1:2195 HIGHWAY 20 SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2028
Practice Address - Country:US
Practice Address - Phone:770-761-1048
Practice Address - Fax:678-607-3095
Is Sole Proprietor?:No
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002984156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician