Provider Demographics
NPI:1033927082
Name:GRAHAM, JASMINE (BSHA, CFM)
Entity type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:BSHA, CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 MONTICELLO DR STE B
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-1940
Mailing Address - Country:US
Mailing Address - Phone:334-676-2797
Mailing Address - Fax:
Practice Address - Street 1:5911 MONTICELLO DR STE B
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-1940
Practice Address - Country:US
Practice Address - Phone:334-676-2797
Practice Address - Fax:334-323-7148
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Single Specialty