Provider Demographics
NPI:1710546809
Name:PATTON, JAZMINE (APC, NCC, CCMHC)
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:
Last Name:PATTON
Suffix:
Gender:F
Credentials:APC, NCC, CCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 TERRACE GREEN TRCE
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3746
Mailing Address - Country:US
Mailing Address - Phone:203-444-6206
Mailing Address - Fax:
Practice Address - Street 1:4045 ORCHARD RD SE STE 110
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4904
Practice Address - Country:US
Practice Address - Phone:770-293-1953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006609101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty