Provider Demographics
NPI:1124712211
Name:SPRINKLE, JASMYNE RENEE (MED, APC)
Entity type:Individual
Prefix:
First Name:JASMYNE
Middle Name:RENEE
Last Name:SPRINKLE
Suffix:
Gender:F
Credentials:MED, APC
Other - Prefix:
Other - First Name:JASMYNE
Other - Middle Name:RENEE
Other - Last Name:NAILOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 MILLWHEEL DR
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-6936
Mailing Address - Country:US
Mailing Address - Phone:678-641-1003
Mailing Address - Fax:
Practice Address - Street 1:120 E TRINITY PL
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3302
Practice Address - Country:US
Practice Address - Phone:404-378-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008698101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health