Individual
JAZZMINE C BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
13570 N MAIN ST, TRENTON, GA 30752-2012
(706) 956-2665
(706) 657-2958
Mailing address
13570 N MAIN ST, TRENTON, GA 30752-2012
(706) 956-2665
(706) 657-2958
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
6416
OK
207Q00000X
Family Medicine Physician
Primary
90864
GA
207Q00000X
Family Medicine Physician
OP61126338
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000211956A
—
GA
Enumeration date
04/18/2017
Last updated
01/07/2022
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