Provider Demographics
NPI:1023404001
Name:PHILPOT, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:PHILPOT
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 1:405 ARROWHEAD BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1254
Mailing Address - Country:US
Mailing Address - Phone:770-742-0446
Mailing Address - Fax:678-802-2125
Practice Address - Street 1:920 DANNON VW SW STE 3203
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2161
Practice Address - Country:US
Practice Address - Phone:678-948-6632
Practice Address - Fax:888-972-3946
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009186235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003177567CMedicaid
GA003177567DMedicaid