Provider Demographics
NPI:1366586422
Name:JASMINE JEFFERS, MD, LLC
Entity type:Organization
Organization Name:JASMINE JEFFERS, MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-941-4810
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-1007
Mailing Address - Country:US
Mailing Address - Phone:770-941-4810
Mailing Address - Fax:770-948-9149
Practice Address - Street 1:3825 MEDICAL PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1109
Practice Address - Country:US
Practice Address - Phone:770-941-4810
Practice Address - Fax:770-948-9149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6196Medicare ID - Type Unspecified