Provider Demographics
NPI:1639850977
Name:HENRY, JASMINE DEIDRE (NP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:DEIDRE
Last Name:HENRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JASMINE
Other - Middle Name:DEIDRE
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1801 PEACHTREE ST NE STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1859
Mailing Address - Country:US
Mailing Address - Phone:404-800-5181
Mailing Address - Fax:
Practice Address - Street 1:10475 MEDLOCK BRIDGE RD STE 820
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4437
Practice Address - Country:US
Practice Address - Phone:404-800-5181
Practice Address - Fax:404-800-5797
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-28
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN191228363L00000X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care