Provider Demographics
NPI:1669154860
Name:SWIFT, YASMINE BRESHAE
Entity type:Individual
Prefix:MS
First Name:YASMINE
Middle Name:BRESHAE
Last Name:SWIFT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:YASMINE
Other - Middle Name:BRESHAE
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:326 GRAYTON WAY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4841
Mailing Address - Country:US
Mailing Address - Phone:478-283-7437
Mailing Address - Fax:
Practice Address - Street 1:326 GRAYTON WAY
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4841
Practice Address - Country:US
Practice Address - Phone:478-283-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA23288410106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician