Provider Demographics
NPI:1568101665
Name:MCINNIS, SHEMIKO (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHEMIKO
Middle Name:
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3645 HABERSHAM RD NE APT 307
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-6204
Mailing Address - Country:US
Mailing Address - Phone:601-270-1632
Mailing Address - Fax:
Practice Address - Street 1:3200 HIGHLANDS PKWY SE STE 420
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5192
Practice Address - Country:US
Practice Address - Phone:678-424-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269311363LW0102X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency