Provider Demographics
NPI:1558542662
Name:BILLINGSLEY, SHAVON CHEREASE (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAVON
Middle Name:CHEREASE
Last Name:BILLINGSLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 LEGACY OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4828
Mailing Address - Country:US
Mailing Address - Phone:770-674-4061
Mailing Address - Fax:770-674-4061
Practice Address - Street 1:1114 NORTHPOINT CIR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4854
Practice Address - Country:US
Practice Address - Phone:770-667-8060
Practice Address - Fax:770-667-2024
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002391152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist