Clarke, Shanelle A.
Clarke, Shanelle A. is an individual health care provider with primary practice located at 1405 Clifton Rd Ne , Atlanta GA 30322-5510. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatric Cardiology, Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine. Allopathic & Osteopathic Physicians / Pediatric Cardiology is her primary health care specialty. Clarke, Shanelle A. can be contacted via phone (404) 256-2593.Contact Information
Primary practice address
1405 Clifton Rd Ne
Atlanta GA 30322-5510
Phone: (404) 256-2593
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Cardiology | 2080P0202X | 74968 | Georgia |
| Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine | 2080P0203X | 50214 | Wisconsin |
Profile Details
| NPI number | 1104973999 |
|---|---|
| LBN Legal business name | Clarke, Shanelle A. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 4th, 2007 |
| Last updated | Jan 22nd, 2021 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104973999 | NPPES |
| Wisconsin | MEDICAID | 34768400 | |
| Wisconsin | MEDICAID | 003170465A | |
| Wisconsin | MEDICAID | 1104973999 |
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