Provider Demographics
NPI:1194583138
Name:WILLIAMS, JASMIN NECHELLE
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:NECHELLE
Last Name:WILLIAMS
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 1:648 HIGHWAY 279
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2606
Mailing Address - Country:US
Mailing Address - Phone:312-998-0855
Mailing Address - Fax:
Practice Address - Street 1:3484 LACHLAN DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6001
Practice Address - Country:US
Practice Address - Phone:404-889-8763
Practice Address - Fax:404-800-0093
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-24-332055106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician