NPI |
1730573858 |
The last name of the provider. If the provider is an individual, this is the legal name. |
Entity Type Code |
1 |
The first name of the provider, if the provider
is an individual. |
Provider Last Name Legal Name |
JASKEVICH |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
MARIANNE |
The first name of the provider, if the provider
is an individual. |
Provider First Line Business Practice Location Address |
445 WINN WAY |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Business Practice Location Address City Name |
DECATUR |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
GA |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address Postal Code |
300301707 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Country Code If outside U S |
US |
|
Provider Business Practice Location Address Telephone Number |
4042943836 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Provider Enumeration Date |
3/26/2015 |
Code identifying the type of other name. Codes are: 1 = former name; 2 = professional
name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other. |
Last Update Date |
3/26/2015 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Gender Code |
F |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Healthcare Provider Taxonomy Code 1 |
1041C0700X |
The city name in the location address of the provider being identified. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The State code in the location of the provider
being identified. |
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |