Provider Demographics
NPI:1083808174
Name:STORY, SHANTISE MCCALL (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANTISE
Middle Name:MCCALL
Last Name:STORY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHANTISE
Other - Middle Name:LAVETTE
Other - Last Name:MCCALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:
Practice Address - Street 1:2400 MT. ZION PARKWAY
Practice Address - Street 2:KAISER PERMANENTE SOUTHWOOD MEDICAL CENTER
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:205-781-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALSB63TA768152W00000X
GAOPT002808152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist