Provider Demographics
NPI:1013557974
Name:FENNELL, SHAMBRILLE U
Entity Type:Individual
Prefix:
First Name:SHAMBRILLE
Middle Name:U
Last Name:FENNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 LAUREL POST DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-8918
Mailing Address - Country:US
Mailing Address - Phone:470-246-2823
Mailing Address - Fax:
Practice Address - Street 1:6330 LAUREL POST DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-8918
Practice Address - Country:US
Practice Address - Phone:470-246-2823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator