Individual
SHAWNTAE GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
345 BROADMOOR WAY, MCDONOUGH, GA 30253-4290
(678) 644-6751
(678) 759-2696
Mailing address
345 BROADMOOR WAY, MCDONOUGH, GA 30253-4290
(678) 644-6751
(678) 759-2696
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003005071A
—
GA
Enumeration date
02/23/2023
Last updated
02/23/2023
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