Individual
SHAKELIA STEPHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4025 N FRASER ST, GEORGETOWN, SC 29440-6659
(843) 372-7304
Mailing address
4025 N FRASER ST, GEORGETOWN, SC 29440-6659
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
178904
SC
Other
Enumeration date
11/07/2016
Last updated
11/07/2016
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