Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

JASMINE NICHOLE JACK MD
NPI 1437737392
Psychiatry & Neurology - Psychiatry in Villa Rica, GA

Q: What is Jasmine Jack's NPI number?

The NPI number for Jasmine Jack is 1437737392. It was assigned to this individual provider in the NPPES registry on March 31, 2021.

Q: What is Jasmine Jack's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Psychiatry, with taxonomy code 2084P0800X.

Q: When was this NPI record last updated?

The NPPES record for Jasmine Jack was last updated on July 17, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since March 31, 2021PECOS Enrolled

20 HERRELL RD, VILLA RICA, GA 30180(110) 812-3530(770) 812-3531 Get Directions Write a Review

NPPES record last updated: July 17, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jul 17, 2026, Jul 9, 2026, Mar 31, 2021 (3 updates tracked since 2021).

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About Jasmine Nichole Jack Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JASMINE NICHOLE JACK MD (NPI 1437737392) is an individual psychiatry provider in Villa Rica, Georgia, licensed in Georgia (113223) and active in the NPI registry since March 2021. She is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1437737392

Entity TypeIndividualFemale

Primary Taxonomy2084P0800X

Provider Legal NameJASMINE NICHOLE JACKCredential: MD

Location Address20 HERRELL RDVilla Rica, GA 30180-5527

Mailing Address20 Herrell RdVilla Rica, GA 30180-5527 · (770) 812-3530 · Fax (770) 812-3531

Phone(110) 812-3530

Fax(770) 812-3531

Sole ProprietorNo

Medical School CMSOtherGraduated 2021

Enumeration DateMarch 31, 2021

Last NPPES UpdateJuly 17, 20263 updates tracked since enumeration

NPPES CertifiedJuly 17, 2026

✔ NPI 1437737392 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · PsychiatryAllopathic & Osteopathic Physicians

Taxonomy Code2084P0800X

License✔ Licensed in GA · 113223

Definition

A Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

20 HERRELL RD, Villa Rica, GA 30180

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jasmine Nichole Jack Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8921537556

PECOS Enrollment IDI20250128002903

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30180 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$164.04 typical visit price

range $53.31 – $164.04

Typical copayment $41.01 (range $13.32 – $41.01)

Most-billed visit code 99205

Established Patient

$66.89 typical visit price

range $16.68 – $133.24

Typical copayment $16.72 (range $4.17 – $33.31)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALLYSON MOFFATT LPC

Counselor (Mental Health)