Provider Demographics
NPI:1710380803
Name:AMRIA, SHEREEN (LAC)
Entity Type:Individual
Prefix:
First Name:SHEREEN
Middle Name:
Last Name:AMRIA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 HOWELL RD STE C
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2096
Mailing Address - Country:US
Mailing Address - Phone:770-304-6627
Mailing Address - Fax:
Practice Address - Street 1:135 HOWELL RD STE C
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2096
Practice Address - Country:US
Practice Address - Phone:770-304-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL237171100000X
GA367171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist