Provider Demographics
NPI:1720793904
Name:MAXWELL, JASMINE (FNP-S)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:FNP-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 JEFFERSON PKWY UNIT 608
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-5874
Mailing Address - Country:US
Mailing Address - Phone:770-837-7286
Mailing Address - Fax:
Practice Address - Street 1:1000 CHASTAIN RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5591
Practice Address - Country:US
Practice Address - Phone:470-578-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN286301163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse