Individual
SHANISE WOOTEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
135 BRADFORD SQ STE A, FAYETTEVILLE, GA 30215-1902
(404) 834-1001
Mailing address
560 JAKE TRL, JONESBORO, GA 30238-8617
(404) 834-1001
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
011147
GA
Other
Enumeration date
06/12/2023
Last updated
06/14/2023
About Stedi
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