Individual
SHAWANICA L ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.C.
Contact information
Practice address
6254 MEMORIAL DR STE F, STONE MOUNTAIN, GA 30083-2884
(770) 795-0506
Mailing address
PO BOX 672842, MARIETTA, GA 30006-0048
(770) 795-0506
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIR008151
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CHIR008151
LICENSE NUMBER
GA
Enumeration date
07/23/2008
Last updated
07/23/2008
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