Provider Demographics
NPI:1104599349
Name:LENIOR, JASMINE MONIQUE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:MONIQUE
Last Name:LENIOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 MARKETPLACE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5750
Mailing Address - Country:US
Mailing Address - Phone:470-338-9517
Mailing Address - Fax:
Practice Address - Street 1:4791 JONESBORO RD STE 3
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-1997
Practice Address - Country:US
Practice Address - Phone:770-969-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-25
Last Update Date:2021-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8146998111744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management