Provider Demographics
NPI:1073283081
Name:SCOTT, SHANNON LAQUITA (CNA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LAQUITA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2393 MARBLERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-7823
Mailing Address - Country:US
Mailing Address - Phone:678-769-8939
Mailing Address - Fax:
Practice Address - Street 1:2393 MARBLERIDGE DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7823
Practice Address - Country:US
Practice Address - Phone:678-769-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0012967181376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide