Provider Demographics
NPI:1588108211
Name:SURAJH, JASMARA DAWN
Entity type:Individual
Prefix:
First Name:JASMARA
Middle Name:DAWN
Last Name:SURAJH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:JASMARA ANGELLA
Other - Last Name:SURAJH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3192 LANDINGVIEW CT
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1402
Mailing Address - Country:US
Mailing Address - Phone:678-451-2688
Mailing Address - Fax:
Practice Address - Street 1:2150 PEACHFORD RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6520
Practice Address - Country:US
Practice Address - Phone:678-615-7032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188464363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily