Provider Demographics
NPI:1437626793
Name:TOURAY, SHAMEKA L
Entity Type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:L
Last Name:TOURAY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SHAMEKA
Other - Middle Name:L
Other - Last Name:FULSTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1122 EVERGREEN WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6237
Mailing Address - Country:US
Mailing Address - Phone:678-458-1424
Mailing Address - Fax:
Practice Address - Street 1:50 LENOX POINTE NE STE A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3170
Practice Address - Country:US
Practice Address - Phone:678-824-6590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor