Individual
SHANEKKIA BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1605 MULKEY RD STE 220, AUSTELL, GA 30106-1127
(470) 956-3760
(678) 398-1930
Mailing address
1605 MULKEY RD STE 220, AUSTELL, GA 30106-1127
(470) 956-3760
(678) 398-1930
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
89381
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2018
Last updated
04/19/2023
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