Individual
DR. SHAVEANDA L. QUEEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5582 MEMORIAL DR, STONE MOUNTAIN, GA 30083-3215
(404) 298-8998
(404) 298-7658
Mailing address
5582 MEMORIAL DR, STONE MOUNTAIN, GA 30083-3215
(404) 298-8998
(404) 298-7658
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
040764
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000717043D
—
GA
Enumeration date
09/20/2006
Last updated
12/15/2014
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