Individual
MISS SHAQUANDA SHANTIVUS GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
825 BELMAR PASS, FAIRBURN, GA 30213-4482
(229) 603-2601
Mailing address
825 BELMAR PASS, FAIRBURN, GA 30213-4482
(229) 603-2601
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2023060174
GA
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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