Basham, Jazzmine C

Basham, Jazzmine C is an individual health care provider with primary practice located at 13570 N Main St , Trenton GA 30752-2012. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Basham, Jazzmine C can be contacted via phone (706) 956-2665.

Contact Information

Primary practice address
13570 N Main St Trenton GA 30752-2012
Phone: (706) 956-2665
Fax: (706) 657-2958
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X OP61126338 Washington
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 6416 Oklahoma
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 90864 Georgia

Profile Details

NPI number 1114451051
LBN Legal business name Basham, Jazzmine C
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 18th, 2017
Last updated Jan 7th, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114451051 NPPES
Georgia MEDICAID 000211956A

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