Individual
KEYANNI JHAMIA SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
6351 DOUGLAS BLVD, DOUGLASVILLE, GA 30135-7102
(404) 267-0400
Mailing address
11409 PANHANDLE RD, HAMPTON, GA 30228-1504
(770) 572-4915
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN122281
GA
1223G0001X
General Practice Dentistry
DGD.9664
SC
Other
Enumeration date
04/05/2019
Last updated
07/22/2021
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