Queen, Shaveanda L.

Queen, Shaveanda L. is an individual health care provider with primary practice located at 5582 Memorial Dr , Stone Mountain GA 30083-3215. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Queen, Shaveanda L. can be contacted via phone (404) 298-8998.

Contact Information

Primary practice address
5582 Memorial Dr Stone Mountain GA 30083-3215
Phone: (404) 298-8998
Fax: (404) 298-7658
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 040764 Georgia

Profile Details

NPI number 1972600922
LBN Legal business name Queen, Shaveanda L.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2006
Last updated Dec 15th, 2014 - about 10 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 1972600922 NPPES
Georgia MEDICAID 000717043D

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