Provider Demographics
NPI:1689139651
Name:BARKLEY, SHONNA (REGISTERED DIETITIAN)
Entity Type:Individual
Prefix:MS
First Name:SHONNA
Middle Name:
Last Name:BARKLEY
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 MANHATTAN PKWY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-2244
Mailing Address - Country:US
Mailing Address - Phone:404-317-5329
Mailing Address - Fax:
Practice Address - Street 1:1921 MANHATTAN PKWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-2244
Practice Address - Country:US
Practice Address - Phone:404-317-5329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD004713133NN1002X, 133V00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty