Provider Demographics
NPI:1316974447
Name:TAYLOR, JASMINE PUGH (MD)
Entity type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:PUGH
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 BOULEVARD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1208
Mailing Address - Country:US
Mailing Address - Phone:404-665-8600
Mailing Address - Fax:
Practice Address - Street 1:265 BOULEVARD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312
Practice Address - Country:US
Practice Address - Phone:404-665-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS162202084P0800X
GA729382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00001785OtherPALMETTO GBA-RAILROAD MED
MS00125299Medicaid
MS260000555Medicare ID - Type Unspecified
MS00125299Medicaid
MSE81258Medicare UPIN
MS302I268869Medicare PIN