Provider Demographics
NPI:1386409159
Name:SHERALD, JAZMIN
Entity type:Individual
Prefix:MS
First Name:JAZMIN
Middle Name:
Last Name:SHERALD
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 1:121 TAYLOR KNOLL WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3750
Mailing Address - Country:US
Mailing Address - Phone:678-767-7053
Mailing Address - Fax:
Practice Address - Street 1:121 TAYLOR KNOLL WAY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3750
Practice Address - Country:US
Practice Address - Phone:678-767-7053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician