Individual
ASHANTI SHANKLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
612 JUNIPER LN, MACON, GA 31220-7648
(478) 501-5198
Mailing address
612 JUNIPER LN, MACON, GA 31220-7648
(478) 501-5198
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
339704
TX
Other
Enumeration date
05/10/2019
Last updated
05/10/2019
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