Provider Demographics
NPI:1003310996
Name:SHRECKENGOST, CONSTANCE SCOTT HARRELL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:SCOTT HARRELL
Last Name:SHRECKENGOST
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:CONSTANCE
Other - Middle Name:SCOTT
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:356 SINCLAIR AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1929
Mailing Address - Country:US
Mailing Address - Phone:404-805-0817
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE RM B206
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1059
Practice Address - Country:US
Practice Address - Phone:404-727-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program