Provider Demographics
NPI:1144794488
Name:MARKHAM SHEPPARD, LLC
Entity Type:Organization
Organization Name:MARKHAM SHEPPARD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:V
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-900-5450
Mailing Address - Street 1:2483 HERITAGE VLG
Mailing Address - Street 2:SUITE # 16 - 335
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078
Mailing Address - Country:US
Mailing Address - Phone:404-900-5450
Mailing Address - Fax:404-900-5453
Practice Address - Street 1:6624 JIMMY CARTER BLVD STE A
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30071-1727
Practice Address - Country:US
Practice Address - Phone:404-900-5450
Practice Address - Fax:404-900-5450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health