Provider Demographics
NPI:1518467703
Name:LOVETT, SHAMONICA LASWE
Entity Type:Individual
Prefix:
First Name:SHAMONICA
Middle Name:LASWE
Last Name:LOVETT
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 1:507 SWIFT ST APT I3
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-6717
Mailing Address - Country:US
Mailing Address - Phone:229-809-4544
Mailing Address - Fax:
Practice Address - Street 1:507 SWIFT ST APT I3
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-6717
Practice Address - Country:US
Practice Address - Phone:229-809-4544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052350661171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor