Provider Demographics
NPI:1962039909
Name:SHAW, INQUASHIA LATRICE (MD)
Entity Type:Individual
Prefix:
First Name:INQUASHIA
Middle Name:LATRICE
Last Name:SHAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 TREEMONT TRCE
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2880
Mailing Address - Country:US
Mailing Address - Phone:770-286-6388
Mailing Address - Fax:
Practice Address - Street 1:4019 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2825
Practice Address - Country:US
Practice Address - Phone:770-533-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96412208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics