Provider Demographics
NPI:1730639774
Name:GARCIA, SHANIQUA (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 BEECHER ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310-2717
Mailing Address - Country:US
Mailing Address - Phone:404-549-2034
Mailing Address - Fax:
Practice Address - Street 1:825 BEECHER ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310-2717
Practice Address - Country:US
Practice Address - Phone:404-549-2034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management