Provider Demographics
NPI:1427644814
Name:WILLIAMS, JASMINE SHERRELL (FNP-BC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:SHERRELL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490411
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30049-0007
Mailing Address - Country:US
Mailing Address - Phone:910-274-4988
Mailing Address - Fax:
Practice Address - Street 1:2805 HAMILTON MILL RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4110
Practice Address - Country:US
Practice Address - Phone:678-541-0588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GATEMPAPRN0191363LF0000X
NC296176163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse