Provider Demographics
NPI:1033756952
Name:JONES-WILLIAMS, SHANTELLE STACY
Entity Type:Individual
Prefix:
First Name:SHANTELLE
Middle Name:STACY
Last Name:JONES-WILLIAMS
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 1:205 HILLSIDE OAK LN
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016
Mailing Address - Country:US
Mailing Address - Phone:248-310-6102
Mailing Address - Fax:
Practice Address - Street 1:4189 WHITE RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4242
Practice Address - Country:US
Practice Address - Phone:470-485-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty