Most Relevant Information
Provider Data
| NPI Number: | 1003649286 |
| Provider Name: | JAZMINE CLARK MSW INTERN |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/22/2024 |
| Last Updated: | 08/22/2024 |
Provider Practice Location
120 E TRINITY PL
DECATUR
GA
300303302
Practice Location Phone/Fax
| Phone: | 4043782300 |
| Fax: |
Provider Mailing Location
120 E TRINITY PL
DECATUR
GA
300303302
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |