Provider Demographics
NPI:1952688434
Name:WILSON, SHEKEMBA (NUSRING AIDE)
Entity Type:Individual
Prefix:MISS
First Name:SHEKEMBA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:NUSRING AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2819 MISTY WATERS DR APT 10
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-6632
Mailing Address - Country:US
Mailing Address - Phone:404-290-1236
Mailing Address - Fax:
Practice Address - Street 1:2819 MISTY WATERS DR APT 10
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-6632
Practice Address - Country:US
Practice Address - Phone:404-290-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028838244376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide