Provider Demographics
NPI:1215534367
Name:POINTER, SHAMEKA RENA
Entity Type:Individual
Prefix:DR
First Name:SHAMEKA
Middle Name:RENA
Last Name:POINTER
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 1:149 S MCDONOUGH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3688
Mailing Address - Country:US
Mailing Address - Phone:770-905-2517
Mailing Address - Fax:
Practice Address - Street 1:149 S MCDONOUGH ST STE 200
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3688
Practice Address - Country:US
Practice Address - Phone:770-905-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010376103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA059668529OtherDRIVERS LICENSE