Provider Demographics
NPI:1134541097
Name:GLOVER, SHONTREKA AKISHA (NP)
Entity type:Individual
Prefix:
First Name:SHONTREKA
Middle Name:AKISHA
Last Name:GLOVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1001 SUMMIT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-6410
Mailing Address - Country:US
Mailing Address - Phone:770-989-1668
Mailing Address - Fax:678-388-1759
Practice Address - Street 1:150 N PARK TRL STE B
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7372
Practice Address - Country:US
Practice Address - Phone:770-507-0909
Practice Address - Fax:770-507-1919
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2018-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN 155519363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner