Provider Demographics
NPI:1346499316
Name:DAFFIN, SHELBY DIANE
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:DIANE
Last Name:DAFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:DIANE
Other - Last Name:HANDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2047 GEES MILL RD NE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1359
Mailing Address - Country:US
Mailing Address - Phone:770-602-0965
Mailing Address - Fax:770-602-0964
Practice Address - Street 1:2047 GEES MILL RD NE
Practice Address - Street 2:SUITE 213
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1359
Practice Address - Country:US
Practice Address - Phone:770-602-0965
Practice Address - Fax:770-602-0964
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator