Provider Demographics
NPI:1275932345
Name:SHEALEY, GLORIA ANN
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:ANN
Last Name:SHEALEY
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 1:3577 MEADOWGLEN VILLAGE LANE APT. N
Mailing Address - Street 2:
Mailing Address - City:DORAVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30340-5321
Mailing Address - Country:US
Mailing Address - Phone:404-407-0006
Mailing Address - Fax:
Practice Address - Street 1:3577 MEADOWGLEN VILLAGE LANE APT. N
Practice Address - Street 2:
Practice Address - City:DORAVILLE
Practice Address - State:GA
Practice Address - Zip Code:30340-5321
Practice Address - Country:US
Practice Address - Phone:404-407-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13-2510246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy