Provider Demographics
NPI:1942901087
Name:LOVE, JAZMINE ALEYAH (PA-C)
Entity Type:Individual
Prefix:
First Name:JAZMINE
Middle Name:ALEYAH
Last Name:LOVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 S CLAYTON ST APT 1226
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-5767
Mailing Address - Country:US
Mailing Address - Phone:908-591-1922
Mailing Address - Fax:
Practice Address - Street 1:450 N CANDLER ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2626
Practice Address - Country:US
Practice Address - Phone:404-501-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty