Active NPI
Jasmine Nichole Jack, MD
- Psychiatry Physician
- Villa Rica, GA
National Provider Identifier
1437737392
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 113223
- Practice address
- 20 Herrell Rd
Villa Rica, GA 30180-5527 - Phone
- (110) 812-3530
- Fax
- (770) 812-3531
- NPI assigned
- Mar 31, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 113223 | GA | Primary |
Addresses
Primary practice location
20 Herrell Rd
Villa Rica, GA 30180-5527
Mailing address
20 Herrell Rd
Villa Rica, GA 30180-5527
Phone (770) 812-3530
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Psychiatry
- Education
- Morehouse School of Medicine, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2014 Washington St
Newton, MA 02462-1607
Phone (617) 243-6000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mass General Brigham Medical Group Suburban Massachusetts Inc | Current | Accepting new patients |
Locations
2014 Washington St
Newtonville, MA 02462
Phone (617) 243-6000
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Newton, MA
- NPI 1538191218
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1617148800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784246400000",
"number": "1437737392",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 HERRELL RD",
"city": "VILLA RICA",
"state": "GA",
"postal_code": "301805527",
"telephone_number": "770-812-3530",
"fax_number": "770-812-3531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 HERRELL RD",
"city": "VILLA RICA",
"state": "GA",
"postal_code": "301805527",
"telephone_number": "110-812-3530",
"fax_number": "770-812-3531"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACK",
"first_name": "JASMINE",
"middle_name": "NICHOLE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-31",
"last_updated": "2026-07-17",
"certification_date": "2026-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "113223",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Villa Rica, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.